Is your urologist's advice out of date?
What your Dr. doesn't know might hurt you
When I was in my early 50's, a routine male health blood panel revealed that I had an elevated prostate specific antigen (PSA) result, which meant my prostate was inflamed and I was at increased risk of prostate cancer.
I was afraid to go to my urologist.
It had been more than a decade since my last prostate exam, and back then my doctor told me I was probably "slightly inflammed." My mind started catastrophizing. I was reading everything I could online about PSA and prostate cancer, and that just made my fears worse.
Was I having difficulty urinating? I didn't know.
Because it's one of the symptoms of a prostate problem, I was trying to self-monitor my urination to detect whether I was symptomatic. Except I became so self-conscious about how I was urinating that I couldn't urinate normally anymore, anyway.
I couldn't talk to my children about it, because I was afraid they would insist that I go to the doctor, have a prostate exam that would probably lead to a biopsy that might lead to a prostatectomy and a life of incontinence and erectile dysfunction.
I didn't want that, so I decided to talk to other men instead.
Risks of biopsy and prostatectomy
In his book Barefoot to Billionairre (Huntsman 2014), entrepreneur and philanthropist Jon M. Huntsman, Sr. (1937-2018) writes about his experience with an elevated PSA on a routine blood test at age 54. He wasn't experiencing any symptoms, but a friend said, "Why not get it checked?"
Huntsman wrote that his decision to have his PSA measured probably saved his life, but I'm not so sure. One of the dangers of early diagnosis is overdiagnosis, which results in iatrogenic risks of medical errors (Overdiagnosed, Welch et al. 2011).
Nevertheless, Huntsman's father died of prostate cancer, so he thought he should have his PSA tested.
His test came back at 4.6 ng/ml. (For comparison, mine 7.0 ng/ml). His doctor told him that about half of men with a PSA above 4.0 ng/ml have prostate cancer, and that the higher the PSA the greater the risk.
Huntsman decided to have his prostate biopsied.
The biopsy itself is an ordeal, and there are cases in which it can go bad. For example, author Mark Sisson's prostate biopsy resulted in a life-threatening sepsis infection. He tweeted a thread about his nightmare.
Huntsman went thru the biopsy process twice. The first time, doctors removed six tissue samples. The second time, they removed eleven.
Two of the tissue samples in the second biopsy tested positive for cancer, and that was enough for Huntsman. He decided to have surgery to remove his prostate - a prostatectomy.
Although Huntsmans wrote that he has no regrets about his surgery, he was surprised that his doctor's didn't reveal to him the full extent of the adverse effects.
I made the decision (to undergo prostatectomy) without a full understanding of what the postoperative ramifications would be. What I didn't know was that the price of relative assurance of long-term survival would be incontinence and impotence. It took me six months to regain my mental, emotional, and physical strength. After a radical prostatectomy, however, a man never truly returns to normal. In my case, the incontinence was overcome within a few months, but the erectile dysfunction was permanent. - Jon M. Huntsman, Sr (2014)
Immediately after his surgery, he experienced urinary incontinence and erectile dysfunction. The incontinence resolved after several months, but that the erectile dysfunction never did.
Huntman wrote that he and his wife Karen miss their sex life, and that he believes men should be better informed of the full range of possible outcomes of prostate surgery.
Well, I took it upon myself to get informed.
Does testosterone increase prostate cancer risk?
In my article The Prostate Protocol I wrote about the men who shared awful stories of their biopsies and prostatectomies, and how I was determined to use a ketogenic diet and ice baths to manage my prostate inflammation instead of visit my urologist. In What Happened to My Testosterone... I described results of that experiment.
My PSA dropped to less than 2 ng/ml and my total testosterone jumped through the roof to 1180 ng/dl. Needless to say, I was ecstatic with the results.
But there was one hitch...
One of the men with whom I spoken said that he'd had a prostatectomy to remove cancerous cells. He experienced the same sort of symptoms as Huntsman did, and he and his wife also missed having intercourse as part of their sex life.
To make matters worse, he said that his doctor had put him on some kind of drug to lower his testosterone, under the (mistaken) belief that the anabolic effects of testosterone might stimulate growth of cancer cells.
If that were really the case, then all the men who are following the same protocol I used to boost their testosterone level could also be putting themselves at higher risk of prostate cancer.
I had to find out.
As it turns out, the belief that high testosterone will increase prostate cancer risk is false. According to a 2014 article in European Urology:
The long held belief that prostate cancer risk is related to high serum androgen concentrations can no longer be supported. Current evidence indicates that maximal androgen-stimulated prostate cancer growth is achieved at relatively low serum testosterone concentrations. - Khera et al. 2014
It turns out that high testosterone is actually better for prostate cancer risk than low (e.g., Yassin et al. 2019).
That would explain some of the results that men are sending me that show they're simutaneously achieving total testosterone levels that are off the charts, while at the same time dropping their PSA, just like I did.
For example, the reader who began the ice bath before exercise protocol who sent me the lab report showing high testosterone? His total PSA was only 2.4 ng/ml.
I can't tell you what course what course of action is right for you. Nothing in this article constitutes medical advice.
All I can do is tell you what happened to me, share with you what other men have told me happened to them, and summarize what some of the scientific journal articles say is happening to others.
No regrets?
Post-humously, Huntsman is probably best known for his philanthropy. According to multiple obituaries, he's one of the few people who has ever donated more than one billion dollars to charitable causes, and his largest beneficiary is probably the Huntsman Cancer Institute at the University of Utah.
Huntsman, who served in the Nixon administration when the President declared "War on Cancer" by creating the National Cancer Institute, wrote that he sought to eradicate cancer. Nonetheless, in Cold Water vs Cancer I wrote about the failures of allopathic treatment options and the fact that 50 years since Nixon's declaration have barely extended the life expectancy of cancer patients.
Huntsman wrote that he has no regrets about treating his prostate cancer risks with surgery, and I'm not here to criticize his choices -- nor anyone's.
I'm here to report that neither do I have any regrets about responding to my elevated PSA with a ketogenic diet and ice baths instead of biopsy and surgery. So far, my decision has worked out pretty well for me.
Dr. Abraham Morgantaler probably agrees. In a recent interview, Morgantaler described how he overturned the popular misconception that testosterone might somehow cause cancer.
References
Huntsman JM. Barefoot to Billionaire. 2014.
Khera M, Crawford D, Morales A, Salonia A, Morgentaler A. A new era of testosterone and prostate cancer: from physiology to clinical implications. European urology. 2014 Jan 1;65(1):115-23.
Welch HG, Schwartz L, Woloshin S. Overdiagnosed: making people sick in the pursuit of health. 2012.
Yassin A, AlRumaihi K, Alzubaidi R, Alkadhi S, Al Ansari A. Testosterone, testosterone therapy and prostate cancer. The Aging Male. 2019 Oct 2;22(4):219-27.
About the Author
Thomas P Seager, PhD is an Associate Professor in the School of Sustainable Engineering at Arizona State University. Seager co-founded the Morozko Forge ice bath company and is an expert in the use of ice baths for building metabolic and psychological resilience.