This letter is for men, who at the first signs of prostate issues, may consider the following tests, steps, and actions before any intrusive tests or treatments. ASPI is about patients talking to patients.
 

“You are not alone” 

I am not in the medical field; I am a 10-year survivor of PCa and have researched for 10 years to interpret articles and websites for answers. I have taught myself a lot about PCa. I wish I knew everything that is written below 10 years ago. It would have given me a good plan for life a lot sooner. My goal as President of ASPI is to help men become more proactive with their health care. 

Screening Phase 1: Proactive information for men who may have BPH, Rising PSA, and men on Active Surveillance. This is from a patient’s point of view. 

Let’s talk about men ages 40-70 years old, who are at risk of prostate cancer. If men have cancer of any form in their family or history or were exposed to agent orange, then they become a medium to high risk candidate for prostate cancer (PCa). It is a known fact that this group of men needs to be more vigilant and be more proactive for the early screening of PCa. This is very important for their quality of life. Early Screening is being proactive and is a safety net. Early detection and research may help them avoid the many pitfalls of prostate cancer. Many of these men will never face treatment with proper lifestyle changes and exercise. Yes, men can live and have a great quality of life once they take charge of their own health care. Their sons could also avoid prostate cancer by making lifestyle changes that will benefit them and potentially prevent the journey their fathers are traveling. 

Building a healthy body is important to fight diseases of any kind, not just cancer. In my opinion, men cannot win the battles of disease without lifestyle changes, exercise, supplements, faith, a positive attitude, will power and a protocol for life. Every part of a man’s body needs to be firing on all cylinders to fight every disease that tries to attack him. It is a process. Focus on winning each battle every day to win the final war. 

I believe I had one opportunity to make lots of changes in my life to fight my cancer battles. 10 years later I am extremely happy that I chose to fight with everything I could put together for a good quality of life. For me, it meant making unpopular choices and changing my life completely no matter who laughed or told me I was nuts. 

I'd like to share an analogy. I started out in a service station when I was 20 years old and immediately learned that to repair vehicles properly, I needed to have diagnostic equipment that would test the engine before and after the repair. I used a lot of different gauges to put together a complete report. The report gave to me a picture of the areas of the engine that needed attention and how soon it needed to be repaired. The diagnostics gauges were used to tell a story of how healthy or unhealthy the engine condition was in. It pointed the technician to the engine parts that were failing. I relate this to PCa by saying let’s test the whole body first. Let's make sure our body is in shape and in good health by first focusing on fixing what is wrong other than cancer. By doing that, then your whole body will help fight cancer and put the dieses back to rest like before we were diagnosed. 

For early detection and to be proactive, there are some good diagnostic tests that can be done prior to any intrusive treatments or tests. These tests will paint a picture and is an early starting point. Many tests can be run by your local MD, if required he or she will work with a Urologist or an Oncologist, based on some of these tests. 

It is recommended that men get a copy or DVD of every test they have run and set up a personal health folder on themselves. Doctors man not read your in-house report prior to your appointment so it is a good idea is to have a copy for them. 

• The C-Reactive Protein (CRP) test: (High Sensitivity) Used by a health practitioner to detect inflammation. CRP is an acute phase reactant, a protein made by the liver and released into the blood within a few hours after tissue injury, the start of an infection, or other cause of inflammation. This is a good test for Cardiovascular (CV) information, and you can use it for monitoring your heart. Men need a healthy heart so they can fight the battles.

• The Comprehensive Metabolic Panel: (CMP) A chemical screen, is a panel of 14 blood tests which serves as an initial broad medical screening tool. The CMP provides a rough check of kidney function, liver function, diabetic and parathyroid status, and electrolyte and fluid balance. This type of screening has its limitations. Men may require more detailed and specific tests. 

• Complete Blood Count (CBC) with Differential/Platelet: It measures the following: white blood cells (WBC), red blood cells (RBC), Hb or Hbg (hemoglobin), Hct (hematocrit).

• Lipid Panel, Reflex to Direct LDL if indicated: Tests for total cholesterol, HDL cholesterol, cholesterol HDL ratio, cholesterol panel This group of tests measures the amount of cholesterol and triglycerides in your blood. Cholesterol and triglycerides are fats (lipids). This panel measures: Total cholesterol is a measurement of both good and bad cholesterol. 

• Homocysteine, Plasma: Homocysteine is a non-proteinogenic α-amino acid. It is a homologue of the amino acid cysteine, differing by an additional methylene bridge. It is biosynthesized from methionine by the removal of its terminal Cε methyl group. Homocysteine can be recycled into methionine or converted into cysteine with the aid of certain B-vitamins. 

• Insulin-Like Growth Factor: (IGF-1) Is a hormone that, along with growth hormone (GH), helps promote normal bone and tissue growth and development. The test measures the amount of IGF-1 in the blood. IGF-1 is produced by the liver and skeletal muscle. 

• Galectin-3: Is a biomarker that appears to be actively involved in both the inflammatory and fibrotic pathways that are thought to be involved & nbsp; Galectin-3 is a carbohydrate-binding lectin whose expression is associated with inflammatory cells including macrophages, neutrophils, and mast cells. 

• Vitamin D: Vitamin D is a group of fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and multiple other biological effects. In humans, the most important compounds in this group are vitamin D3 and vitamin D2. Cholecalciferol and ergocalciferol can be ingested from the diet and from supplements. 

• Testosterone: Is the primary male sex hormone and an anabolic steroid. In male humans, testosterone plays a key role in the development of male reproductive tissues such as testes and prostate, as well as promoting secondary sexual characteristics such as increased muscle and bone mass, and the growth of body hair. In addition, testosterone is involved in health and well-being, and the prevention of osteoporosis. Insufficient levels of testosterone in men may lead to abnormalities including frailty and bone loss. Very important for your health, energy and sexual performance. Research is needed on this hormone. There are two sides to the story and both sides need to be explored. Research Testosterone Therapy. 

• Estradiol (Salvia) 

• Estrone (Saliva) 

• Thyroid Panel II: T4 Free, T3 Free with TSH: This test delivers an enhanced thyroid profile, because it screens for the level of free T4 and T3 hormones in the bloodstream. This is an important distinction, since the level of free T4 hormone illustrates how much is immediately available for uptake and use by cells, and measure of free T3 hormone in the body is considered a more accurate view of hormonal balance than a total T3 reading. In addition, this test also measures the level of thyroid-stimulating hormone (TSH) produced by the pituitary gland. This test result will indicate if your body is producing too much—or too little—of this critical hormone, which regulates T4 and T3 output. 

• Balance Men’s Hormones: Very important to know all your hormones are balanced. You need every weapon in your arsenal to fight your battles. 

• Spectracel Nutrients Tests: SpectraCell’s Micronutrient test provides the most comprehensive nutritional analysis available by measuring functional deficiencies at the cellular level. It is an assessment of how well the body utilizes 33 vitamins, minerals, amino/fatty acids, antioxidants, and metabolites, while conveying the body’s need for these micronutrients that enable the body to produce enzymes, hormones, and other substances essential for proper growth, development, and good health. This test provides the basis of a personalized, functional approach in addressing a broad variety of clinical conditions including arthritis, cancer, cardiovascular risk, diabetes, various immunological disorders, metabolic disorders and micronutrient deficiencies. I have run this test for several years and know exactly what I had to work on for my health. Think about a man’s total health before any treatments. If a man’s body is not right to start with how can he win any battles? Going into battle with one hand tied behind your back is a losing proposition. 

Proactive Tests: Pre-Biopsy 

• Prostate Specific antigen: (PSA) This is not a perfect test but as part of a group of tests it is very important. Prostate-specific antigen, also known as gamma-seminoprotein or kallikrein-3, is a glycoprotein enzyme encoded in humans by the KLK3 gene. PSA is a member of the kallikrein- related peptidase family and is secreted by the epithelial cells of the prostate gland. PSA is produced for the ejaculate, where it liquefies semen in the seminal coagulum and allows sperm to swim freely. It is also believed to be instrumental in dissolving cervical mucus, allowing the entry of sperm into the uterus. 

• PSA Total + % Free: Prostate Cancer will have a higher bound PSA ratio. An enlarged prostate and prostatitis will have a higher free PSA ratio. If your free PSA results are less than 25%, your risk for developing prostate cancer is between 10% to 20%. If your free PSA results are less than 10%, your risk for developing prostate cancer jumps to around 50%. 

• PSA Complexed: This PSA test is a Complex Prostate Specific Antigen test and is more sensitive than a standard PSA test. Prostate Specific Antigen (PSA) is currently one of the screening tests for prostate cancer and prostate disorders. 

• Prostate Acid Phosphatase: (PAP) This is a reliable early test and should be a part of any arsenal. Prostatic acid phosphatase, also prostatic specific acid phosphatase, is an enzyme produced by the prostate. It may be found in increased amounts in men who have prostate cancer or other diseases. 

• Navarro HCG Urine Immunoassay: as a Cancer Diagnostic by FACT the Navarro HCG test is a noninvasive urinalysis that can, with a high degree of accuracy, detect cell activity which may be indicative of a precancerous or cancer condition. 

• MDx Test: SelectMDx for Prostate Cancer Measures Biomarkers That Help a Physician Determine if a Patient is at Higher or Lower Risk for Prostate Cancer and Which Men Can Safely Avoid Biopsy.

• A non-invasive urine test (“liquid biopsy”), Select MDx measures the expression of two mRNA cancer-related biomarkers (HOXC6 and DLX1).1 The test provides binary results that, when combined with the patient’s clinical risk factors, help the physician determine whether: 

• The patient may benefit from a biopsy and early prostate detection.

• Digital Rectal Exam: (DRE) The digital rectal exam is a physical examination of the rectum, the last few inches of the bowel, just above the anus. The doctor uses a gloved and lubricated finger to check for abnormalities of the anus and rectum. The physician is feeling for any nodules on the outside of the prostate gland. 

• 4K Score test:  This test is a new tool for Urologists to help clarify the prostate cancer biopsy decision. Learn how the 4Kscore measures a patient’s risk for aggressive prostate cancer 

• One of the best Biochemical Full Body Scan available without radiation exposure www.americanmetaboliclaboratories.net Longevity Profile®© - The works! (Cancer Profile TM©, estradiol, progesterone, total testosterone, IGF-1, PTH o homocysteine, hs-CRP, LDL-Direct, L p(a), Cortisol a.m. & p.m., Chem/CBC). The He-Profile© DHEA-S, IGF-1, Prostate Specific Antigen (PSA), Estradiol, Progesterone, Total Testosterone, Chemistry 24/CBC with Differential. The CA ProfileTM© generally yields 87 to 97 positives out of 100 pathologically established malignancies. Because of its capacity to foretell the development of malignancy years before a tumor is apparent, a positive finding is a serious warning sign of a developing cancer. The CA ProfileTM© can also be used to monitor the response of cancer patients to various therapies. An increasing value of a tumor marker may indicate the futility of a certain therapy as well as its possible toxicity. On the other hand, if the markers are decreasing, it can indicate a therapy is working. 

• One of the best tests on the market today is the Exo Dx by Exosome Diagnostics Inc. This is a liquid Biopsy urine test that will show low, intermediate and aggressive prostate cancers. www.exosomedx.com. This may replace biopsies and is great for monitoring any man on AS. 

Before a Biopsy Consider: 

If a yellow flag shows up, then there are still test options that will stage any issues in the prostate including PCa without a biopsy. 

• Color Doppler: Color Doppler Cutting edge technologies. Color Doppler is a medical imaging technique utilized to offer visualization of the blood flow by using color processing to add color in the image so that a doctor can see what is happening inside the body. I have followed my PCa for 4 years with this test. 

• Micro-Ultrasound System Scan: A revolution in ultrasound, operating at 29 MHz Micro-ultrasound resolution is comparable to MRI and 300% improvement over conventional ultrasound. Assessing the diagnostic accuracy of micro-ultrasound for the detection of clinically significant prostate cancer: Results from a single-institutional experience. Much less intrusive and can be done by a Urologist or Oncologist in their office. You do not need a whole team. 

• 3T mpMRI: MutiParametric: Prostate 3T MRI. Prostate 3T MRI is a noninvasive imaging technique that does not utilize exposure to ionizing radiation. This Multiparametric MRI study uses a contrast agent, or dye, that is vital to the exam. Computer Aided Detection (CAD) is used to help the DIS radiologist identify lesions suspicious for prostate cancer. More accurate for higher grade cancers but not as good for low to medium grade cancers. Be sure to find out what contrast agent they are going to use, and check it out first. 

• Gadolinium, long-term retention is in question and has new cautions from the FDA. Be sure to talk to your physician and do your own research. The 3T mpMRI can be imaged without any transfer contrast agent. 

• 3T mpMRI: New BiParametric: BiParametric MRI does not use any transfer agents such as Gadolinium. This is a safe way with today’s technology and should be the preferred way of imaging for today’s patients. The images are comparable to contrast agents provided you have an experienced radiologist. Safer for patients and less intrusive with the same results. 

• PET/CT PET, Positron-emission tomography is a nuclear medicine functional imaging technique that is used to observe metabolic processes in the body as an aid to the diagnosis of disease. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radioligand, most commonly fluorine-18, which is introduced into the body on a biologically active molecule called a radioactive tracer. Different ligands are used for different imaging purposes, depending on what the radiologist/researcher wants to detect. Three-dimensional images of tracer concentration within the body are then constructed by computer analysis. In modern PET-CT scanners, three-dimensional imaging is often accomplished with the aid of a CT X-ray scan performed on the patient during the same session, in the same machine. CT, A computerized tomography scan combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside your body. CT scan images provide more-detailed information than plain X-rays do. PET/CT Scans are imaged with Axumin or Gallium 68 PSMA (Check availability) check with your physician. 

• A Targeted Biopsy can be performed if necessary. It can be performed after these tests or at the time of these imaging tests based on the patients staging level. 

Understanding all these tests will give patients the information to have a two-way conversation with their physician. He or she will respect you for it. To be more involved with health care decisions will make your cancer journey much easier and a lot less stressful. 

Consider that some of these tests may not be covered by insurance. If you have a question, call the Insurance Company or Medicare for preapproval. 

Gene D. Slattery President Active Surveillance Patients International (ASPI). glattery.aspi@gmail.com.