Beyond PSA - Additional Biomarkers for Assessing Prostate Function

In my previous article on assessing prostate function I talked about the crucial role that prostate-specific antigen (PSA) plays in men’s health. However, PSA levels alone aren’t enough to diagnose prostate cancer, which is why I want to talk about other primary biomarkers for prostate cancer that we need to consider.

Tumor cells produce specific products that play a role in the growth, spread, and metastasis of the tumor. We can measure many of these products, which are known as biomarkers, in the blood. An increase in tumor activity and size is often accompanied by an increase in these biomarkers. The following are some of the biomarkers for prostate cancer that you should be aware of:

Prostatic Acid Phosphatase (PAP)

I firmly believe that you should be running baseline PSA tests and following the results over many years. I also think you should run a baseline PAP and regularly check this test as well. PAP levels will begin to rise when prostate cancer has begun to spread beyond the capsule to other parts of the body. Unlike PSA it is less likely to be elevated from other causes and is helpful for monitoring the effectiveness of treatment and as an independent predictor of recurrence. Levels above 3.0 ng/mL are associated with a higher probability of disease outside the prostate.

Prolactin

Prolactin is a hormone produced in the pituitary glands of both men and women. Pioneering work by Dr. Nevalainen and colleagues at Georgetown University Medical Center showed that prolactin serves as a local growth factor for prostate cells.[i] Normal levels of prolactin in men are 2.17 to 17.7 ng/ml.

Other biomarkers to consider:

D-Dimer

Because prostate cancer can cause higher risk of thrombosis, it’s a good idea to keep track of D-dimer levels, a sensitive marker of coagulation. D-dimer can indicate if the patient has an existing clot or a risk of a clot. Most doctors would read levels between 0-1 as acceptable, being fairly certain no clot is indicated. But as a functionally oriented physician, I like to see D-Dimer levels below .40, which to me is the optimal range.

Fibrinogen

This is a very important test in predicting cancer development or progression. Fibrogen is the precursor of fibrin. Research suggests that cancer cells use fibrin to coat themselves in order to slow down their recognition by the immune system.

Like D-dimer, fibrogen can also be a good predictor of blood clots. Patients with cancer often show a hyper-coagulation state with elevated fibrinogen playing a major role. Anti-coagulant drugs such as heparin, which break down fibrin in the body, have been shown to improve survival rates.

Levels are best kept below 350 mg/dl

Interleukin-6 (IL-6) and C-Reactive Protein (CRP)

It is known that inflammation is involved in prostate cancer development and progression. IL-6 and CRP are two of the inflammatory markers that have been most strongly connected with prostate cancer. High C-reactive protein levels in men are associated with a 40% higher risk of prostate cancer and a high pre-diagnostic IL-6 reading may lead to a less than optimal prostate cancer outcome.[ii] High levels of IL-6 and CRP may be responsible, at least in some part, to creating an environment in which cancer is more likely to develop and progress.

I like to see numbers of CRP below 0.55 mg/L for men and 0.8 mg/L for women, and levels of IL-6 below 150 pg/mL

Insulin and Metabolic Syndrome

There seems to be a link between insulin resistance and prostate cancer. So it’s a good idea to keep an eye on fasting insulin, glucose, hemoglobin A1C, IGF-1, C-peptide, lipid panels and leptin levels.

There is more and more research coming out on preventing, tracking, and treating prostate cancer. I have only introduced the topic of blood testing for prostate disease, with the aim of illustrating the possibilities that exist. I urge all of you Functional Medicine practitioners to use what’s available to help your patients, and to keep up with the exciting advancements in this field. That’s why Optimal DX offers an annual FBCA Mastery Training Program that comprehensively discusses the various biomarkers practitioners can test for in their patients’ blood, their significance and their holistic context — including those biomarkers that may help in a prostate cancer diagnosis. You can sign up for the training waitlist here

References

[i] Nevalainen, M. Researchers Discover Effective Method For Killing Prostate Cancer Cells, AScribe News, Inc. May, 2003, Georgetown University Medical Center

[ii] Stark, JR., IL-6, CRP Levels Tied to Prostate Cancer Development, Lethality, American Association for Cancer Research's Frontiers in Cancer Prevention Research Meeting in Boston, Nov. 2006., Reuters Health Information 2006.

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