Prostate Specific Antigen (PSA) is a specific protein of about 34,000 molecules compounded and secreted by prostatic epithelial cells to the seminal fluid and one of the main components of seminal plasma. PSA can decompose the colloidal protein in the seminal fluid, and it plays a role in diluting the seminal fluid. If PSA secretion is too low, the liquefaction time of seminal fluid will increase, causing male infertility. Therefore, PSA is a normal physiological substance secreted by human prostatic acinus and epithelial cells of ducts. PSA is not a carcinogenic substance.
In a normal prostatic ductal system, there exists a vascular-epithelial barrier and prostate envelop barrier. These barriers prevent the PSA produced by the prostate epithelium from entering directly into the blood. Thus, a low concentration of serum PSA is maintained. A PSA less than 4.0 ng/ml in the serum is considered normal.
Two factors closely related to the serum PSA concentration are (1) the prostate vascular-epithelial barrier and prostate envelop barrier, and (2) prostate epithelial secretion.
1) The prostate vascular-epithelial barrier and prostate envelop barrier directly affect serum PSA levels. Malignant and non-malignant pathological changes that damage the prostate vascular-epithelial barrier and prostate envelop barrier can cause serum PSA elevation.
Prostate cancer often causes malignant pathological changes to occur. At the first and second clinical stages of prostate cancer (stages I-II), if the prostate cancer does not damage the prostate vascular-epithelial barrier or prostate envelop barrier, the serum PSA concentration will usually remain within the normal range or will not rise higher than 10 ng/ml. At the third and fourth clinical stages of prostate cancer (stages III-IV), the prostate cancer has damaged the prostate vascular-epithelial barrier and prostate envelop barrier. The serum PSA concentration is usually more than 10 ng/ml. Under the bone-metastasis condition, the serum PSA concentration can be more than 100 ng/ml.
If the prostate cancer severely damages the prostate vascular-epithelial barrier and prostate envelop barrier, the barriers are slow to recover. Also, the reduction of the serum PSA concentration is slow or does not reduce continuously after the prostate cancer cells and tumors are effectively killed and cleared. Such are the cases in patients with damage barriers receiving the 3D Prostate Cancer Targeted Treatment. Thus, patients need to take oral medicines that can accelerate the mucosal epithelium grow, and repair the prostate vascular-epithelial barrier and prostate envelop barrier. And, then the serum PSA concentration can return to normal.
Non-malignant pathological changes include prostatitis, BPH, acute urinary retention, ejaculation, prostate massage, prostate biopsy, and trans-urethral resection of the prostate. If the non-malignant pathological changes have affected and damaged the prostate vascular-epithelial barrier and prostate envelop barrier, the changes can cause an increase in serum PSA concentration. If the damage caused to the barriers is not severe, and the non-malignant lesions are broken down and cleared, then the barriers can recover quickly. The serum PSA concentration should gradually return to normal.
2) Factors affecting prostatic epithelial cell secretion and PSA concentration. For the prostate cancer patient, it is important to understand, PSA is not a cancer marker produced by the prostatic cancer cells. PSA is a normal physiological substance compounded and secreted by the prostatic epithelial cells to support the seminal fluid. The concentration of PSA compounded and secreted by the prostatic epithelial cells, is controlled by the endocrine hormones; especially androgens, estradiol, and prolactin.
The prostate contains abundant sexual hormone receptors. Any factor affecting the pituitary gland, adrenal gland, and testis axis that causes endocrine hormone disorder can affect serum PSA concentration. For example, factors causing the absolute or relative blood concentration of androgen, estradiol or prolactin increase can increase serum PSA concentration secreted by the prostatic epithelial cells. On the contrary, factors causing the absolute or relative blood concentration of androgen, estradiol or prolactin decrease can decrease serum PSA concentration secreted by the prostatic epithelial cells. Also, attempts to lower serum PSA concentration surgically or by medicine should be considered carefully or avoided. For example, the commonly used castration treatment, surgically or by hormone therapy (prostate cancer endocrine therapy), should not be considered. In fact, castration treatments show no direct therapeutic effect on the prostatic cancer cells and tumors. Often, they do more harm than good.
In summary, prostate specific antigen (PSA) should not be used as the diagnostic criteria for prostate cancer. Nor should PSA be used as the criteria to determine if relapse has occurred after prostate cancer treatment. Many clinical studies on prostate cancer indicate problems with the PSA test. These problems include false positive results and the over-diagnosis of prostate cancer (the diagnosis of cancer when cancer does not exist). Also, when the PSA diagnostic result is positive (higher than normal), the patient often undergoes more examinations including prostate biopsy, which create complications and risks, such as, infection, bleeding, cancer cell spread from the needle track, and urinary incontinence. False positive cancer reports based on elevated PSA levels cause patients to receive unnecessary treatment resulting in many adverse side effects, pain, and suffering. Therefore, many scholars suggest PSA should not be used to screen for prostate cancer.
However, one should not disregard the PSA in prostate cancer screening. The PSA is an important secondary indicator. It can tell us if an unhealthy condition exists within the prostate. For the diagnosis of prostate cancer, the PSA should only be used as a secondary indicator. Primary indicators for prostate cancer include patient symptoms, physical examination, digital rectal examination (DRE), microscopic examination of the expressed prostate fluid (EPS), trans-rectal ultrasound (TRUS), magnetic resonance imaging (MRI), microscopic examination of the expressed prostate fluid (EPS), and miRNA.
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Contact Person: Alisa Wang