When your PSA starts to rise after you have received primary treatment you need to be concerned that your prostate cancer has reoccurred. The first indicator of recurrent prostate cancer is a detectable level of prostate-specific antigen (PSA).

Research has demonstrated that PSA doubling time is a reliable tool to distinguish which cancers pose a greater risk for death from prostate cancer. PSA doubling time is the time it takes for PSA levels in the blood to increase by 100 percent (see the nomogram under the resourse section of this blog to calculate your PSA doubling time).

We believe that a PSA doubling time of less than three months after therapy indicates a very high risk of imminent death from prostate cancer. A doubling time of three to twelve months also suggests a significant risk for the development of systematic disease and prostate cancer-specific death. For those who are more fortunate, a PSA doubling time of one or more years poses a much lower risk of death from prostate cancer.

A very small clinical trial of 48 participants, over a six year period, was conducted evaluating the potential role of pomegranate juice in controlling the rate of PSA doubling time. All the subjects had a rising PSA after prostate cancer surgery or radiotherapy (primary treatment), a PSA greater than 0.2 ng/ml and less than 5 ng/ml and a Gleason score of 7 or less.

Drinking only eight ounces of pomegranate juice daily consisted of the entire treatment protocol for all subjects. Currently, in the sixth year of this treatment, active subjects who remain in the study have a median total follow-up of 56 months. These participants continue to experience a significant decrease in PSA doubling time following treatment, from a mean of 15.4 months at baseline to 60 months post-treatment, with a median PSA slope decrease of 60 percent, 0.06 to 0.024.

Researchers compared active patients, who remain on the study, with non-active patients, who no longer remain on the study. Though these two groups demonstrated similar mean PSA doubling times at baseline, both the PSA doubling time prolongation and the decline in median PSA slope were greater in active patients who were drinking the pomegranate juice when compared to non-active subjects.

“This study suggests that pomegranate juice may effectively slow the progression of prostate cancer after unsuccessful treatment,” said Christopher Amling, an American Urological Association spokesman. “This finding and other ongoing research might one day reveal that pomegranate juice is an effective prostate cancer preventative agent as well.”

Parts of this ongoing study suggest that some patients may be more sensitive to the effects of pomegranate juice on PSA doubling time. Phase three of this study is currently underway to further evaluate the benefits of pomegranate juice in a placebo-controlled manner.

There have been other indications that pomegranate juice can effect cancer tumor growth and progression. You can read about some of these other indicators by searching the blog for pomegranate.

My biggest concern about pomegranate juice is the very high sugar content of the prepared juice. Most of us do not need, as a matter of fact, we are much better of not consuming this level of sugar. I would like to see similar studies using pomegranate extract to be scientifically sure that the extract will in fact have the same effect as the juice seems to have. Since I have gained significant weight, which I still carry from the course of hormone therapy, I have elected not to consume the juice, but I do take an extract pill every day.

1. Pantuck, A; Zomorodian, N; Rettig, M; Aronson, W; Heber, D; Belldegrun, A. Long term follow up of phase 2 study of pomegranate juice for men with prostate cancer shows durable prolongation of PSA doubling time. J Urol, suppl. 2009: 181, 4, abstract 826.
2. Michael Blute, Matthew Tollefson, Bradley Leibovich, Jeffrey Slezak. Mayo Clinic Department of Urology.

Joel T Nowak MA, MSW