Depending on what study you look at, the chance of a man being diagnosed with prostate cancer sometime in his life is about one in five or six. Now that’s a sobering number in itself, but here’s something more to think about. A recent autopsy study on the incidence of prostate cancer shows that it is present even in men as young as 20. And although this information may seem shocking, it can pave the way to a better understanding of what causes prostate cancer, and therefore how you can prevent it.
An autopsy study is one in which researchers ask the question, “I wonder how often people have a particular cancer that goes undiagnosed.” So in order to find the answer, they go to a hospital and obtain the tissue from the bodies of people who have died from other causes. Then they methodically examine the tissue under a microscope, carefully identifying any cellular signs of the cancer they are looking for.
In this case, researchers at Wayne State University School of Medicine in Detroit, Michigan were curious about prostate cancer. So they obtained the prostate glands of 1,056 men whose doctors had not diagnosed prostate cancer prior to death. The men were between 20 and 80 years old.
Of 186 prostate glands from 20-year-old men, 19 had prostate cancer. Yes, you heard me right. That amounts to 10% of these young men.
And, as expected, the number of men with prostate cancer increased with age. Among men in their 30s, the researchers found that 31% had prostate cancer! When men hit their 40s, the number jumps to 40%. And by the time a man is 60 years old, according to this autopsy study, his chances of having prostate cancer is 70%.
These numbers are much higher than the numbers of men whose doctors actually diagnose prostate cancer. So how can it be that so many men can have a prostate cancer that goes unnoticed? And what are the implications of this data?
Everyone Over 60 Has Cancer
Doctors are finally realizing that most people have cancer in their body. But it’s latent – or hidden – cancer. Latent cancers are so well contained by the immune system that they never get large enough to cause problems. As a result, doctors rarely discover them, unless they discover them by accident. Most of the cancers they discovered in this autopsy study were latent cancers. And, as you can see, they are very common.
Autopsy studies on women, for example, show that by the time a woman hits 40 years old, the chances of her having a latent breast cancer is 40%! That’s one in every two-and-a-half women that have cancer cells in their breasts.
Now that sounds terrible, doesn’t it? It’s really not terrible! In fact, the existence of latent cancers is very reassuring. They clearly demonstrate how effective a healthy immune system can be in stopping cancer.
It’s so effective that the great majority of latent cancers never go on to become full-blown cancers. And that’s good news. When you start to add up all of the various autopsy studies that are published, you soon realize that every single one of us over the age of 60 has cancer. Actually, we have at least two of these cancers already living in our bodies. But the really important thing about latent cancers is that they can teach us a lot.
The first thing they teach us is that by maintaining a healthy immune system, we can dramatically decrease our chances of dying from cancer.
Take me, for example. I’m 72 years old. Therefore, I have at least two cancers in my body. They are not diagnosed, but they are there. They might be in my colon, my prostate, my lung, wherever. I don’t know where they are because, right now, they are latent. My immune system is covering them.
But what will happen to me if my immune system stops working as well as it has been? What if I start stressing a lot? Or what if I suddenly decide not to exercise, or to abandon a healthy diet? What if, as I get older, I become deficient in the hormones that are so important for optimal immune system function? Or what if I develop a serious injury, a bad dental infection, or some other immune-depleting problem? What then?
It’s pretty obvious. If that were to happen, I shouldn’t be too surprised if one of those latent cancers progresses to a clinically detectable cancer in the next few years.
So here’s what the whole idea of latent cancers tells me: It emphasizes the importance of maintaining a lifestyle that optimizes my immune system as best as I can. It also emphasizes the importance of discovering a latent cancer that’s breaking out into a full-blown tumor as early as possible. That way I can get a handle on it before it gets too far down the road.
So what’s the best way to do this?
PSA — A Less Than Perfect Test
Your doctor will tell you to get a PSA test and a digital rectal exam every year. But this autopsy study suggests that’s not nearly enough. All of the men in the study had a normal result on both of these tests. In fact, another study says these tests are not very accurate at all.
In 2004, the New England Journal of Medicine published a study that reveals just how inaccurate a “normal” PSA reading of less than 4 ng/ml can be.
The authors of the study wondered how often men with both a normal PSA (less than 4 ng/ml) and a normal rectal examination actually had prostate cancer.
These researchers must have done some fast talking. Somehow or another they managed to talk 2,950 men into having their prostates biopsied simply as part of their research. None of these men had any indication at all that they were any more likely to have prostate cancer than the average man with normal tests.
What they found was startling. Of these nearly 3,000 men, 449 men actually had cancer despite their normal test scores. That’s one in eight!
That means that for every eight men who have normal findings, one of them has cancer. And the doctors missed it. What’s more, the actual number of the PSA score doesn’t offer much help either.
• 6.6% of the 449 had an extremely low PSA that was less than 0.5.
• 10.1 % had PSAs between 0.6 and 1.0.
• 17.0 % had PSAs between 1.1 and 2.0.
• 23.9 % had values of 2.1 to 3.0.
• And 26.9 % had levels between 3.1 and 4.0.
The Right Way to Use Your PSA Score
We’ve already seen that the best way to know if you have prostate cancer at the earliest possible stage is not the PSA or the digital rectal exam. But there is another way. It’s called PSA velocity testing.
With PSA velocity testing, it’s possible to diagnose an early cancer even when the PSA and the rectal are normal.
PSA velocity is a term that describes how high the value of a man’s PSA tests increase in one year. For example, if a man has a PSA test and it’s 0.5 higher than it was the year before, he has a PSA velocity score of 0.5. If the last time he had a PSA was five years ago, and this year’s test was 1.0 higher, then his PSA velocity is 0.2, or 1.0 divided by the five years.
As a man gets older, due to the normal age-related increase in prostate size, his PSA is likely to rise ever so slightly. But as long as the PSA velocity is minimal, the odds are that if he has a latent cancer, his immune system is still keeping it in that state. In fact, a PSA velocity of 0.03 or less per year has been shown to be accurate proof that no prostate cancer exists. That should be what we shoot for. Although the values may vary slightly from year to year, there should not be any consistent overall increase greater than 0.03.
However, a PSA velocity of 0.15 ng/ml over three consecutive years is a different story. This means it’s likely that a latent cancer is starting to break out into a full-blown low-grade cancer. A faster PSA velocity is more ominous. When the PSA velocity is greater than 0.35 ng/ml over a three-year period, the odds are that the latent cancer is turning into a high-grade cancer.
And all of this is true even if the highest PSA number is still in the “normal range.” So any PSA velocity greater than 0.15 should be a cause for immediate treatment.
But I’m not recommending surgery, radiation, or even a biopsy in this early state. After all, at this early point, the elevated velocity probably just represents a latent cancer and not a dangerous situation.
Instead of aggressive procedures, I have found that in this early state, the great majority of men will almost always respond to natural therapies. These include exercise, changes in diet, supplements, stress control, etc. Most of the time, that’s all it takes to stop the rise. And in many cases, it can actually reverse the disease.
So what’s a good game plan that we can come away with after seeing the results of this important autopsy study?
You Really Can Self-Diagnose Prostate Cancer
All men should have a PSA performed on their 40th birthday. For a 40 year old, the value should be less than 0.6 ng/ml. If it’s higher than this, he should start a natural therapy program right away.
Regardless of how old you are when you start having your PSA, keep a good record of each test score. As the years go by, get out your calculator and determine your PSA velocity. If you haven’t been getting annual checks, then you can still figure it out by determining the difference in values between your last PSA reading and your current reading. Then divide this difference by the number of years in between readings. That will give you your PSA velocity. As I said earlier, if your PSA velocity is less than 0.03, you are home free (at least for the time being). But if it’s greater than 0.15, it’s time to get to work.
Brawer, M.K., M.A. Rennels, R.B. Nagle, R. Schifman, and J.A. Gaines. “Serum prostate-specific antigen and prostate pathology in men having simple prostatectomy.” Am J Clin Pathol. 1989 December;92(6):760-4.
Carter, H.B., L. Ferrucci, A. Kettermann, et al. “Detection of Life-Threatening Prostate Cancer With Prostate- Specific Antigen Velocity During a Window of Curability.” J Natl Cancer Inst.2006 November 1; 98(21): 1521-1527.doi:10.1093/jnci/djj410.
Powell, I.J., C.H. Bock, J.J. Ruterbusch, and W. Sakr. “Evidence Supports a Faster Growth Rate and/or Earlier Transformation to Clinically Significant Prostate Cancer in Black Than in White American Men, and Influences Racial Progression and Mortality Disparity.” The Journal of Urology, vol. 183, 1792-1797, May 2010.
Thompson, I.M., D.K Pauler, P.J. Goodman, et al. “Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level 4.0 ng per Milliliter.” N Engl J Med
2004; 350:2239-2246, May 27, 2004.