"That's a good article on the prostate by the way, a nice non-technical, or not too technical summary. I suppose another way to think about testing for PSA is a bit like a smoke alarm. If it goes off, there may not actually be a fire, but it's always good to carry out a few simple tests first just to make sure there isn't, …" - Peter Davis, pathologist

Introduction and Background

This is not a definitive guide to prostate health or to the functioning of the prostate gland. Nor am I an expert. I am a guy who is interested in health generally both as a professional body therapist and as a human being – and I start with my own health.

Neither do I have anything to sell.

Probably like you, or your husband/partner/boyfriend if you are a female reading this, I knew little about the prostate gland for many years. I thought it had something to do with sperm production (it does) but that was about all. I never referred to it as the ‘prostrate’ gland though! Then as I went through my late 50s and early 60s (I am now 63) I started to have slight problems with peeing, ie urination. I never reached the stage of having to get up several times a night or having to force it, but none-the-less there was clearly some sort of problem.

I happened to move to Warwick in 2008, and when I registered with a new doctor in mid-2009 I requested a blood test to measure Prostate Specific Antigen, usually known as PSA. My doctor, fortunately, agreed. Some refuse, I understand – and you can insist.

The reading came back as 5.3. The first question then was, “well, what does that mean?” At that stage my doctor actually confessed that he was not well up on men’s health specifically as the vast majority of his patients were female or children. I found this refreshingly honest of him. He did say that the PSA reading was above ‘normal for my age’ (‘normal’ being approximately 4) but not seriously so, and that we should monitor the levels every three months.

So, already I had met two problems; a doctor with little specific knowledge and a lack of certainty on the interpretation of the numbers.

Maybe it is a reflection on the focus of medicine and health that there is no agreed international standard scale for PSA measurement. Even within the scale we use there seems to be no UK-wide agreement as to what constitutes a serious problem at the lower end of the scale which is where it really matters. If you had a reading of (say) 50 you could immediately say there was a serious problem, but if it was (say) 11, is that serious or just a bit worrying?

Some doctors would rush you off for a digital rectal examination or a biopsy and others would say, “let’s keep an eye on it.”

In my case, being only a ‘little high’, regular monitoring every three months seemed like a sensible optio to both of us. In the meantime, I thought, I can do some research myself if the doctor knows little. I learnt a lot.

On one of my visits to the Post Office I spotted a notice stating that the Graham Fulford Charitable Trust (GFCT) was in Warwick giving a talk about Prostate Cancer and offering free PSA tests. In fact Graham lives near Warwick but does go to other parts of the country to give talks etc. (See the resource list later.) So I went along and, being a curious soul and knowing by then the variability of the test, decided to have a test from them.

I continued to have tests from both the GP surgery and the Trust as you can see from the table below, which lists the results from my readings over the next couple of years:

The GFCT doctor is not great at record keeping but does have a really good heart and a lot of experience in the field. So, when my reading was at 5.4 according to their test lab, he sent me a letter advising me to take further action and see a consultant. So, you see, not only is there variability in the numbers, there is also variability in the interpretation of those numbers. They have kept following up on this, despite the change in my readings.

It’s one of those interesting things about science that when it puts a scale on something it thinks that is enough! And yet it is the scientists who interpret that scale that then decide what it means. And no-one takes into account the infinite variability of each human.

Personally, I think advising someone of 62 to take further action (which usually means see a consultant) when a man’s reading is 5.4 is a bit premature. We should be advising him to look at his health and immune system and work from the inside out rather than the outside in. But more of that later.

My way of alleviating my symptoms and reducing the PSA reading from 6 at its highest to 3.2 at its lowest was with diet (although I was already a vegetarian and I cook most of my food myself from raw ingredients), supplementation, alkalising (bi-carb) and lots of Reiki.

And, I have not found a single doctor interested in how I did this.

For now, a little bit of biology:

Where is it?

The prostate is positioned just below the bladder and surrounds the urethra. The urethra is the tube that carries urine from the bladder through the penis and outside. It also carries the semen during ejaculation.

How big is it?

The prostate is tiny at birth but after puberty it enlarges, with rising levels of testosterone. In an adult man it is about the size of a walnut. (Dependent upon the size of the man of course!) Unlike other glands, which stop growing, it continues to grow very slowly throughout life

What does it do?

It makes the liquid of semen. Sperm are produced in the testicles and then stored just behind the prostate in the seminal vesicles in a ‘jelly’. At orgasm and ejaculation, the prostate and seminal vesicles contract, mixing their respective contents which liquefy the jelly to aid movement of the sperm in its search for an egg (ovum).

What is the Prostate Specific Antigen?

It is this substance within the fluid in the prostate that liquefies the gelatinous sperm mixture.

Now on to a bit of science:

The fluid PSA leaks into the bloodstream, so every man will have a certain amount in his blood. Although I use the term ‘leak’ this is not like a plumbing leak which you want to stop. It is perfectly normal and, as far as we are aware, should be happening.

The amount that leaks varies with every single man on the planet. There is no ‘norm’.

However, this is why doctors can take a blood sample and test it for PSA. And why the test is unreliable.

What do the numbers mean?

The test measures the amount of PSA present in your blood in nanograms per millilitre (ng/ml). The amount in the blood tends to increase with age anyway and, although there is no normal (I stress this again), science does suggest what you might expect, depending on your age.

So, in a purely logical/scientific way, all it tells you is that you have so much PSA in your blood and, by implication, how much leaks. Now, I don’t know if or how the PSA is removed, for example by the liver or spleen. So does it simply build up over the years or what? So as you see, it cannot be a terribly reliable test, but it is the only one we have so we must make the best use of it.

Anything other than the number is an interpretation and will depend on the opinion of the person giving it to you. So, always insist on being given the actual number of the result. If the person says it is ‘normal’ or anything else, just ask for the number. Then you can make your own interpretation and have a discussion with your doctor. Don’t just rely on his or her opinion as, like mine, he or she may know little about it.

How Consistent are the Results?

There are different ways of measuring PSA. Thus depending on the method and the scale used you will get different results from different laboratories. You may have noticed the variation in readings of my results.

This is just one reason why the test is not perfect, and if your reading is just ‘a little high’ you should monitor it for a while – whilst taking action to change it, of course. (Monitoring and doing nothing is useless.) The GFCT doctor did say to me that if the level goes up and down then be happy. In fact there are other reasons why it may vary: for example some places advise not to ejaculate for at least 24 hours before, and some say 48 hours. But if they don’t tell you before you go that could skew the result.