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Posted October 29, 2019

Chinese Herbal Supplement May Raise PSA

Use of a Chinese herbal supplement appears to have significantly increased the PSA (prostate specific antigen) level in a man treated for prostate cancer, erroneously suggesting a recurrence of the cancer (Abel, J Am Osteopath Assoc 2019).

The man had been treated 30 months earlier with radioactive seed implantation for prostate adenocarcinoma, the most commonly diagnosed malignant tumor in men. His PSA level had, as expected, decreased following the treatment. An increase in the level suggested possible recurrence of the cancer. However, after further discussion with the patient, his doctors found that the increase in PSA (from 1.2 ng/mL to 3.4 ng/mL) coincided with the patient taking a Chinese herbal supplement, Jin Gui Shen Qi Wan (one 750 mg tablet daily), which consists of 12 herbal ingredients. The supplement had been recommended by an acupuncturist.

The man was instructed to discontinue the supplement and his PSA level decreased from 3.4 ng/mL to 2.3 ng/mL within one week and to 1.0 ng/mL within three weeks, eliminating the need for further investigation, such as biopsy.

His physicians found that the herbal product includes three ingredients (Fo-Ti, Goji, and Schisandra) that are inhibitors of cytochrome P450, which is involved in metabolizing (breaking down) testosterone and other hormones. Theoretically, inhibiting cytochrome P450 can raise testosterone levels, stimulating the prostate and increasing PSA production.

The physicians noted that, although the patient claimed that he did not remember why he took the supplement, radioactive seed implantation in the prostate commonly causes erectile dysfunction. Jin Gui Shen Qi Wan (or Jin Kui Shen Qi Wan) is among the Chinese herbal products used to treat erectile dysfunction (among other applications) (Ma, Asian J Androl 2011).

The physicians stressed the importance of comprehensively assessing patients. The case also highlights the importance of informing healthcare providers of the supplements one is taking.

Note: There is anecdotal evidence that use of nicotinamide riboside (also called Niagen and found in the product Elysium Basis) may also raise PSA levels.

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