Are 'gremlins' plaguing your PSA levels?
Sex, bike riding, meds Thursdays, Fridays and spring days can cause PSA rises
By Howard Wolinsky
Sometimes tending to our prostates and Prostate Specific Antigen (PSA) testing is a lot like caring for Gizmo and other Mogwais from the 1980s hit movie, “Gremlins.”
There’s a list of simple rules that no one seems to follow to the T. Mayhem can ensue with a population explosion of Mogwais or gremlins or unintended Rising PSAs.
The Mogwai rules are:
Never expose it to sunlight.
Never get it wet.
Never, ever feed it after midnight.
(Got a gremlin in your prostate?)
Gremlins are defined as mischievous sprites imagined as the cause of mishaps to aircraft. More generally: such a creature is imagined as the cause of any trouble or mischance and also an unexplained problem or fault.
We definitely can run into gremlins that affect our PSA level, enough to push us over the “gray zone” of 4 or 10.
If you’re monitoring your PSA, there are the 48-hour rules but also some others and there are other factors that probably no one has mentioned to you, such as slight seasonal effects on PSA levels and also medication that can artificially inflate your results—falsely up or down.
You’ve heard it a million times. No sex and no bicycle riding within 48 hours of being tested.
And yet we numbnuts routinely break the 48-hour rules and end up with PSAs higher than they really are.
What is it about bicycling and prostate cancer?
Loads of us ride bikes. Let’s rule out bike riding as a cause of prostate cancer. But it definitely can raise our PSA levels.
I know for those with incontinence from prostatectomies—or with enlarged prostates—anxiously keep an eye out for bathrooms on their bike routes.
Is there something about bike seats that pressure their junk and prostates and can lead to PSA elevation? And are you bike riders so addicted to the ride that you forget to lay off 48 hours before having blood drawn for a PSA?
Talking about laying off … Why do guys forget the no-sex rule 48 hours before testing?
Are these PSA flubbers simply forgetful?
Or could be they are tweaked on weed-- "yin yang huo,” a Chinese herb better known as horny goat weed that allegedly helps with sexual dysfunction? Warning: Benefits for erectile dysfunction from yin yang huo, dispensed by the same sort of Chinese herb shops that sold Gizmos, are not proven.
(Horny goat weed in the raw form.)
Then, is your doctor inadvertently causing your PSA to rise with some rough stuff during a prostate exam?
My friend Ira told me his urologist at Northwestern (Go Wildcats) tended to order a PSA after a rigorous prostate exam. Ira’s PSA scores showed t higher than they actually were. He finally told his doc that the physical exam was causing his PSA to rise.
This one sounds like a Gremlin rule. A PSA immediately after a prostate exam apparently is a bad idea. (Do Mogwais even have prostates?)
My former urologist told me that the time of year—and day of the week— had been shown to raise PSAs. Here’s an article on this phenomenon.
Irish researchers found small variations in PSAs based on calendar factors.
Check this out:
—PSA seems higher in the spring. Was British poet laureate Alfred Lord Tennyson on the mark when he noted: “In the Spring a young man's fancy lightly turns to thoughts of love.” Why not old guys’ PSAs, taking a turn in spring, too? Seems goofy, but why not chart your PSAs and see what happens in the springtime?
—PSA rises slightly on Thursdays and Fridays. Are libidos ramping up for the weekend? Weird, but check it out and let us know.
The researchers said (highlights added):
“Data from 53,224 men aged 45-74 years, with an initial PSA <10.0 ng ml(-1) were correlated with temperature (°C), duration of bright sunshine (hours), and rainfall (mm). There was seasonal variation in PSA levels, with median PSA being higher in spring compared with other seasons (1.18 vs 1.10 ng ml(-1), P = 0.004). Seasonal variation was not apparent when PSA levels were age-adjusted (P = 0.112). Total PSA was not correlated with daily, weekly, or monthly hours of sunshine, rainfall or mean temperature. In contrast, age-adjusted PSA varied with weekday, with higher PSA levels on Thursday and Friday compared with other days (1.16 vs 1.10 ng ml(-1), respectively).”
One more factor: Medications can cause PSAs to rise—or fall—sending the wrong message.
Kevin Ginsburg, MD, MS, a urologic oncologist at Karmanos Cancer Institute/Wayne Health and assistant professor of urology at Wayne State University School of Medicine in Detroit, explained how meds could boost PSA scores.
Ginsburg, a prostate expert in Michigan’s famed MUSIC group, said: “Many medications work by either accelerating or blocking a step in a cascade the body uses building up or breaking down various substances, proteins, or chemicals. This commonly occurs in the liver. A lot of medications can affect liver function and subsequently how the liver breaks down specific chemicals or medications. Sometimes medication A can cause an increase in the serum concentration of medication B. Alternatively, medication A can cause a decrease in the serum concentration of medication B.
“PSA is metabolized by the liver. This means the liver is responsible for breaking PSA down and excreting it from the body. So certain medications can increase or decrease the serum concentration of PSA if those medications affect the proteins in the liver that are responsible for breaking down PSA. Alternatively, some medications may cause the prostate to make more or less PSA (such as finasteride or testosterone.)”
(Kevin Ginsburg, MD)
Ginsburg said, as a result, some medications may affect serum PSA concentrations:
“Although the level of PSA may change slightly due to medication (maybe a PSA of 4 vs. 2, but I wouldn't expect a difference of 4 vs 400), this should not be interpreted as that the medications are changing the risk of cancer development or progression (in either direction: a medication making the PSA go down does not necessarily make the risk of prostate cancer lower or a medication making the PSA go higher does not necessarily make the risk of cancer higher).”
According to Drugs.com: Some medications can increase levels of PSA) in the blood, falsely indicating the presence of prostate cancer.”
Medications that may raise PSA levels include:
Betamethasone, a steroid prescribed to reduce inflammation
Testosterone replacement therapy, including Jatenzo, a testosterone capsule for men with certain forms of hypogonadism, a condition that occurs when your sex glands produce little or no sex hormones.
How does this pertain to those of us on AS?
“PSA is only a number and one of many factors to consider while on AS, and although PSA may be helpful in many situations to monitor for disease progression, it is often one of the least important factors while on AS (at least to me),” Ginsburg said.
So guys, don’t freak out if your PSA nudges up a little. Consider whether any of these factors may be giving your PSA a boost. Go easy on your bike riding when necessary, track the seasons and days of the week when you are tested, and steer clear of horny goat weed when it’s PSA time.
Just for the record, other drugs may lower PSA levels in patients, which may indicate a false-negative result. These include:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen
Cholesterol-lowering statins, such as Lipitor (atorvastatin) and Zocor (simvastatin)
High blood pressure drugs known as thiazide diuretics
Medications used to treat an enlarged prostate or male pattern baldness, such as Proscar and Propecia (finasteride) and Avodart (dutasteride).