Questions you should ask if you’ve been diagnosed with prostate cancer

Prostate cancer is the most commonly diagnosed cancer in men in the U.S. after skin cancer, with 248,530 new cases projected to be diagnosed in 2021. We talked with Geovanni Espinosa, N.D., L. AC., a naturopathic and functional medicine doctor who specializes in treating prostate cancer and other male urological conditions about what questions you should ask your doctor about your diagnosis.

Dr. Espinosa is the first naturopathic physician to complete an internship, residency, and fellowship in urology at a conventional medical institution—Columbia University, New York. He is the author of numerous scientific papers and books, including Thrive Don’t Only Survive. He also lectures internationally on the application of science-based holistic treatments for urological conditions. 

PinnacleCare (PC): Does diet play a role in prostate cancer treatment?

Dr. Geovanni Espinosa (GE): The right diet is one important component of keeping cancer at bay. We’re trying to create a microenvironment inside the prostate that’s hostile to cancer cells and a plant-based diet does that. Your diet should also include fish, especially salmon that’s poached or cooked at a low heat. You should engage in some intermittent fasting.

C: What is the positive effect of intermittent fasting on prostate cancer?

GE: If you combine intermittent fasting with exercise, what seems to happen is that chemicals like tumor necrosis factor and Interleukin 6, which are pro-inflammatory and pro-prostate cancer, are minimized. On average, obesity makes prostate cancer worse, so intermittent fasting can also help you lose weight and improve your overall health.

PC: What are some of the questions people with prostate cancer should ask their doctor?

GE: People often wonder, if they have a high prostate-specific antigen (PSA) level, should they get a biopsy? What counts as a high PSA? The normal range is anything between 0 and 4. Even if a person has a high PSA, they may still be reluctant to get a biopsy because it is an invasive procedure.

First, let’s talk about whether or not a PSA is good biomarker for prostate cancer. The truth is that, while PSA is an imperfect biomarker, it is a good indicator of overall prostate health. The reality is that, with just a PSA test, there’s no way of knowing for sure if you have prostate cancer. You can’t diagnose prostate cancer with an ultrasound or other methods. There is no way to know for sure without a prostate biopsy.

PC: Are there other factors to consider when thinking about a biopsy if you have a high PSA?

 GE: It’s also age-dependent. If you’re 66 and have a high PSA, you probably don’t need a biopsy. If you’re 56, I would recommend doing another PSA in three months and some other tests. If you’re 42 and you have a high PSA, that’s a little more concerning. As a man gets older, his PSA can increase for a lot of benign reasons. However, if a man is under 50, and his PSA is rising, you’d want to take additional steps to determine what’s causing the high PSA.

PC: What additional tests can help your doctor reach a diagnosis?

GE: It’s good to tell your doctor upfront if you’re interested in avoiding a biopsy if possible. If a patient isn’t advocating for himself, the doctor or surgeon might not even offer the possibility of additional tests.

If you don’t want a biopsy yet, there’s the 4Kscore, which is more sensitive than a PSA test. A score above 7.5 is more indicative of prostate cancer. We’re looking for cancer that is most likely to metastasize and become lethal. The 4Kscore ignores lower risk disease and focuses on disease that’s riskier.

There is also a urine test called the ExoDx Prostate Cancer test. That test does not use PSA or require a digital rectal exam. You do not need both the 4Kscore and an ExoDx test.

The third thing you want to know is if you have any genetic germline mutations specific to prostate cancer. There are about 12 prostate cancer-specific genetic mutations. The most significant is the BRCA2 mutation. People with this mutation have a much greater likelihood of having more aggressive prostate cancer.

If any of these test scores are high or you have the BRCA2 mutation, the next step is to get an MRI, preferably a 3 Tesla MRI. This type of MRI gives you a Prostate Imaging Reporting and Data System (PIRADS) score between 1 and 5, which indicates the likelihood of the presence of a more aggressive cancer. The higher the score, the more likely it is that that aggressive cancer is present.

After you gather all this information, you can be an active participant in this conversation with your doctor and determine if you need a biopsy.