Blood metrics

This is certainly not meant to be an all inclusive list of metrics. It is only a list of ones that I have found that I think might be of value. I only include units on a few of them. If you want specific details on one let me know and I’ll do my best to answer your questions.

Note that my blood metrics are from 09/2020 to 10/2020. Updated blood test results are in the “Therapies and current status” post.

There are a number of blood tests that give insights to general health, cardiac risk, and PrC outcome.

I’m going to take a stab at what I track, the ratios that I calculate, and what they mean.

PSA. I get an ultrasensitive PSA test. Test is uPSA.

The ultrasensitive test isn’t needed if your PSA is above 0.2 or so (then a standard PSA test should suffice). But I had RP surgery and my PSA is 0. So I need the resolution (wish I could get the resolution without the cost!).

Good or bad PSA varies widely depending on therapies, surgery, radiation, no treatment, etc. After surgery the desired level of PSA is zero. After radiation the level might be higher since the prostate still exists and continues to make PSA. If you are on testosterone replacement therapy or high testosterone your PSA might be higher since other tissues (as well as any prostate cells) are potentially “encouraged” to produce PSA. And please remember, PSA is a marker, it is NOT cancer.

CEA is a general cancer cell test. Test is CEA.

Most doctors don’t think it has a lot of value since the results can vary and a high value is not necessarily a sign of cancer. When I told my oncologist that I would like to track my CEA and would look at trends and not a particular reading, she warmed up considerably to the idea.

Normal is less than about 3.5 and the lower the better (everyone has cancerous cells in their body so a nonzero value is normal and not to be alarmed about).

NLR is neutrophil to lymphocyte ratio. Test is CBC.

Formula is neutrophils divided by lymphocytes.

Most studies indicate that you want an NLR below 2.1 (2.1 cutoff).

dNLR is neutrophil/(WBC count – neutrophil). Test is CBC.

Lower the better and cutoff is 1.4.

PNI is prognostic nutritional index. Tests are CBC and CMP.

Formula is 10xalbumin + 5 x lymphocytes (if results are k/ul or k/mm^3).

Example: For average normal values of Albumin 4.5 g/dl and 2500 Lymphocytes per μl, or mm^3, the PNI formula gives: 10×4.5 + 0.005×2500 = 45 + 12.5 = 57.5

The higher the better and lower cutoff is 50.2.

PLR is platelet to lymphocyte ratio. Test is CBC.

The lower the better and the upper cutoff is 100.7.

mGPS is modified Glasgow prognostic score. Test is HsCRP and CMP.

If your HsCRP (high speed CRP – a special test) is <10 the mGPS is 0.

If HsCRP is >10 but albumin is >3.5 the mGPS is 1.

If HsCRP is >10 and albumin is <3.5 the mGPS is 2.

The lower the better (zero is best).

HsCRP is high speed c reactive protein. Test is HsCRP.

HsCRP correlates with inflammation. Lower the better. Mine is 0.16 and anything below about 1 is good.

Fibrinogen requires a special test. It is a protein that the body uses to help clot blood.

The lower the better. Upper cutoff is 236.

Calcium. CMP test.

Calcium in the blood could indicate bone breakdown – therefore possibly bone mets.

Anything between 8 and 10.5 is good.

Carbon Dioxide. CMP test. Lower is more acidic and is correlated with worse PrC outcomes.

Normal is 20-35. I think a good target range is 27-35. Very easy to increase by taking sodium bicarb, potassium bicarb, and magnesium bicarb. Some of us need to watch the sodium from the sodium bicarb. My blood pressure seems to increase if I get too much sodium. Therefore I mix the 3 types.

In August of 2019 my carbon dioxide was 19. I started taking bicarbonates and it was 25 in a week and has gone up since then. This is a parameter that is extremely easy to manipulate.

Globulins are a group of proteins made by your liver that help fight infections and clot blood. CMP test. Normal range is 2.1 to 3.6.

AST, ALT, and ALP (alkaline phosphate) indicate liver function and are part of the CMP test. You don’t want these to be high. Desirable ranges are:

AST 10-35

ALT 10-35

ALP 30-120

CBC panel includes RBC and WBC. Red blood cell count and white blood cell count. I don’t know if you want these to be high or low. WBC is a window into your immune system. If low then perhaps you don’t have enough immune fighters. If high then perhaps you are sick or are fighting cancer. So I’m going to guess that moderate is best. If RBC is too low then you can suffer from anemia and fatigue. Too high and your cardiac risk goes up. Note that ADT will decrease both counts.

Normal ranges are 4-6 for RBC and 3.4-6 for WBC.

D or D-hydroxy is a special test. Very important. Ideal range is 26-38 ng/ml (65-95 mmol/l). Most Americans are low. Many large NIH studies and studies from other countries and other organizations show that serum D levels are highly predictive of all cause mortality, cardiac risk, and cancer death. If D goes too high then it becomes toxic (hence the upper limit). If too low then mortality risk increases. This one is also easy to change. Mine was around 25 (slightly low). I started taking 75kIU a week of vitamin D and raised it to 180kIU within a few months. Serum D was too high so I decreased my D to 25kIU/week and my next measurements were 88 and then 86. My wife’s vitamin D was 18. I put her on 150kIU/week and now her serum D level is over 100 so she’s reducing to 10kIU/week.

A1c% is a special test and shows average glucose. Avg glucose should be in the 70-95 range. High values could possibly lead to diabetes and higher cardiac risk.

Lipids are checked with a lipid panel.

LDL

HDL

VLDL

Total cholesterol

Triglycerides

For all my life LDL and total cholesterol have been rather high. LDL has ranged from 100-150. My total cholesterol has almost always been over 200 and sometimes exceeds 240.

In 2019 I started taking red rice yeast. The brand I got has about 5mg of monacolin K (same ingredient as in lovastatin). So I made sure I got about 20 mg a day of monacolin K (update 06/2020: I pulse 2 weeks of 80 mg at night with 2 weeks off – some research suggests that at a lower dose, the monacolin K might actually promote PCa but at higher doses it helps destroy it). I also took beta sitosterol (I took a product that contains plant stanols and sterols and beta sitosterol is the main component). In 3 months my cholesterol was reduced from 229 to 126. My LDLs went from 151 to 65. By far this is the lowest that they have ever been. I don’t think you want to go too low though. Lipids serve important roles in the body.

I’m not sure if extremely low cholesterol is good however. Cancer mortality and all-cause mortality studies show a U-shaped curve with lowest mortality if cholesterol is moderate (180-220 mg/dl). I suspect that there might be confounding variables though and many theories support the idea that PCa feeds off of LDL cholesterol. If they are correct then I assume the ideal LDL range might be lower for PCa patients.

LDL-P is usually not included in a standard lipid test panel and you need to get a specialized detailed lipid profile. LDL-P seems very predictive of cardiac risk. Ideal is perhaps 730-1100.

ApoB is a specialized test and is one of the best predictors of cardiac risk. Ideally it should be 50-96.

IGF-1 is a negative for PrC. It requires a special test. Levels are very age dependent and should decrease markedly as you get older. A good range for a 50-70 year old is perhaps 70-110.

There are a few other blood metrics that I look at but I haven’t seen as many good research surrounding them.

The tests that I get every month or so are ultrasensitive PSA, CBC, and CMP. Every few months I have D status and lipids tested. I also have some hormone tests done; I am interested in DHT, estradiol (E2 or frequently labeled estrogen by labs – I need an ultrasensitive made for men), total testosterone, SHBG (with total testosterone and albumin – part of CMP – free and bioavailable testosterone can be easily calculated and are quite accurate in my experience).

The other tests I have done once or twice a year. And there are a few others that are good to get based on your specifics (I keep an eye on B-12, Folate, Iron and TIBC).