Understand PSA Doubling Time

Prostate cancer is the most common type of cancer in senior males. In Europe, the incidence is higher than 200 cases per 1000 male population. 

It also ranks second as the most common cause of cancer death in males. It is undoubtedly a disease we should address through an early diagnosis and prompt treatment. 

That is why many studies have focused their attention on prostate cancer screening.

In an attempt to detect prostate cancer before it grows very large, doctors started to use the Prostate Specific Antigen (PSA). 

The PSA test was found to be a good tool to detect cancer in patients without symptoms. But it also bears problems because it sometimes gives positive readings in patients without cancer. Additional tools have been developed in response to PSA failure to provide exact results.

PSA kinetics was brought in an attempt to see what happens with PSA readings over time. Researchers started to determine cancer risk based on how this value changed through the years. That is why we now have something called PSA velocity.

But they also found another PSA value known as PSA doubling time. This one was found to predict cancer aggressiveness. It was also helpful in patients after receiving prostatectomy or radiation therapy.

But what is PSA doubling time, and when is this test recommended? You will find the answer to this question and more in the present article.

What is PSA doubling time?

Before understanding PSA doubling time, we should know how serum PSA value behaves over time. It is not like hemoglobin levels which stay the same throughout our lifetime. 

Instead, males are expected to experience a rise in their serum PSA level as they grow older. That is normal and expected in healthy patients, but such an increase should follow a specific pattern.

PSA velocity measures the rising pattern of PSA levels in each person. Based on these readings, we can get a new PSA after a while and check if the patient follows the same pattern. 

If they do, a prostate cancer diagnosis will be unlikely. Localized prostate cancer may cause a discreet increase in PSA velocity. In most cases, metastatic prostate cancer is preceded by an aggressive rise of these values.

Now, PSA doubling time is a similar PSA kinetics reading. It measures how much time it takes for PSA to double its value. 

It has proved useful to predict overall survival and detect aggressive cancer or determine its progression. Moreover, doctors use this measure in patients after prostatectomy or radiation therapy to detect biochemical recurrence (1).

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What can PSA doubling time indicate?

Unlike PSA velocity, PSA doubling time is not used as a prostate cancer screening method. Instead, it is used in patients already diagnosed or in the process of being diagnosed. 

PSA doubling time is much more specific in these patients, especially if they happen to have a higher tumor grade. But it is also used in patients who have already received treatment for prostate cancer. In each case, it may indicate something different (1):

  • In the early stage of prostate cancer diagnosis: Fast PSA doubling time may indicate the possibility of metastasis or advanced prostate cancer. For many cases, the rapid PSA increase rate is correlated with the Gleason score (2). Thus, even if the measurement is not commonly used before treatment, new studies suggest a possible role in these patients, too (1).
  • In prostate cancer follow-up: In patients with ongoing cancer, fast PSA doubling time may indicate progression to metastatic disease (2).
  • After prostate cancer treatment, rapid PSA doubling time indicates biochemical recurrence survival after radical prostatectomy or radiation therapy. These patients may not have physical signs of prostate cancer aggressiveness. But they have a biochemical progression of prostate cancer, which is detected in serum PSA (3).

Still, it is essential to note that some studies report contradictory results. Some of them demonstrate no correlation between fast PSA doubling time and the histological stage of prostate cancer. 

But we’re dealing with clinical oncology, which is very complex and highly variable in different populations. Thus, although still imperfect, it is a tool that has helped in the past to make accurate predictions (1).

Reasons for a fast PSA doubling time

Why would your PSA level double after radical prostatectomy? The reasons vary for each patient. For example, you may not have a visible tumor, but PSA doubling time will be very fast in metastatic disease. Also, after radiation therapy, your tumor may still display progression towards metastasis.

In the early stage of diagnosis, the main reasons for fast PSA doubling time include:

  • Aggressive disease
  • High Gleason score
  • Metastasis

Remember that prostate cancer cells create PSA, too. The tissue divides rapidly and continues releasing this blood marker. Local inflammation increases blood vessel contact with the tumor, and PSA leakage to the bloodstream rises. All of these factors influence PSA doubling time in prostate cancer.

What is a normal PSA doubling time?

There is not a single PSA doubling time reading considered safe. Instead, PSA doubling time works within ranges, and each is associated with a given prognosis. For instance (4):

  • PSA doubling time equal to or lower than 12 months is associated with a 50% chance of death within five years of biochemical relapse.
  • PSA doubling time higher than 12 months is associated with a 10% chance of death within five years of biochemical relapse.

Some authors have also proposed a more complex association that considers PSA doubling time coupled with the Gleason score. They found that PSA doubling time was handy to predict progression to metastasis in patients with a Gleason score lower than 8.

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Natural ways to reduce PSA doubling time

Initially, prostate cancer treatment and follow-up are important to reduce PSA doubling time. 

After following a treatment course, you can also try natural methods. All methods to reduce your PSA level are also helpful to reduce PSA doubling time. For instance:

1. Follow a healthy diet

Remember that some foods have a higher inflammatory profile than others. PSA values increase in the presence of inflammation. So, it is recommended to stay away from saturated fats and irritants of the urinary tract.

2. Exercise regularly

Each case is different, and some patients feel fatigued and have a low tolerance to exercise. But the more active you are, the more likely it is to increase the survival rate. Your PSA level is more likely to stay in control, too.

3. Manage your stress levels

Believe it or not, PSA may also increase if you don’t know how to cope with stress. Different relaxation methods such as yoga and meditation may modulate prostate cancer outcomes. They could even keep PSA scores under control in some cases.

4. Antioxidant foods and supplements

Free radicals contribute to the inflammation and the destruction of healthy prostate tissue. Thus, consuming antioxidant foods is essential to keep inflammation and PSA levels at bay. 

A standard recommendation for these patients is green tea. It is known to modulate prostate cancer by taking care of hormonal imbalances and protecting the gland against free radical damage. Other anti-inflammatory foods, herbs, and supplements can also do the trick.

Conclusion

PSA doubling time is mainly useful for prostate cancer patients who underwent treatment. After treatment, it gives doctors a prognosis of aggressiveness. 

PSA doubling time lower than 12 months is associated with a higher chance of cancer-related death. Studies also show that a fast doubling time may predict the risk of metastasis.

You can keep your PSA level under control through a healthy lifestyle and using anti-inflammatory and antioxidant foods and herbs.

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Sources

  1. Folkmanis, K., Hajjar, A., Junk, E., Merdane, E., Folkmanis, V., Folkmane, I., & Isajevs, S. (2021, September). Prostate Specific Antigen Dynamics and Features in Prostate Cancer. In Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. (Vol. 75, No. 5, pp. 328-334). https://sciendo.com/article/10.2478/prolas-2021-0047 
  2. Heidenreich, A. (2008). Identification of high-risk prostate cancer: role of prostate-specific antigen, PSA doubling time, and PSA velocity. European urology, 5(54), 976-977. https://pubmed.ncbi.nlm.nih.gov/18640768/ 
  3. Schmid, H. P., McNeal, J. E., & Stamey, T. A. (1993). Observations on the doubling time of prostate cancer. The use of serial prostate‐specific antigen in patients with untreated disease as a measure of increasing cancer volume. Cancer, 71(6), 2031-2040. https://pubmed.ncbi.nlm.nih.gov/7680277/
  4. Vickers, A. J., & Brewster, S. F. (2012). PSA velocity and doubling time in diagnosis and prognosis of prostate cancer. British Journal of Medical and Surgical Urology, 5(4), 162-168. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375697/

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