Hi Everyone,
My husband was diagnosed 5/7/04. Was on ADT2 for 10 years. Used DES, then Zytiga, then docetaxel now has been on Enzalutimide since June last year. Enzalutamide has brought his PSA down to 15, the lowest that it has been for 5 years. He is now on a bit of a plateau. I have read a bit about Metformin and wondered if this was possibly something that could be added.
Any comments/ observation would be most welkcome.
Thanks,
Carol2
I'm not sure Carol2. I'm hoping someone with the knowledge will get you a answer soon. My husband is on metformin but not the same medications as your husband.
Carol, I have been on metformin since 2011 - shortly after beginning ADT2 in 2010 due to the failure of salvage radiation to the pelvic floor in 2009 (Radical Retropubic prostatectomy in 2006). I began it to fight the tendency towards metabolic syndrome that ADT brings, but have since read many articles about its probable (in some men) suppression of CaP growth as well... a very happy serendipity.
I have continued taking 4 metformin tablets a day through sipileucel-T immunotherapy and now almost 2 years at the NIH in a clinical trial using enzalutamide plus Prostvac-Tricom immunotherapy. In my case I cannot help but feel that metformin has played a synergistic role alongside my other meds.
I have been on metformin for a couple of years as it was recommended by my oncologist at MD Anderson. It is inconclusive if it has had any affect on my PSA or cancer, but it is inexpensive drug, so I continue to take it. Jim
Hi Carol2,
Glad that you found us, welcome.
Metformin is a very inexpensive drug that has been around for a long time. It is approved for and is an old standby treatment for diabetes. It has almost no negative effects. It would probably cause his glucose blood levels to drop, for most of us that is a positive outcome.
There has been a move to re-purpose some of these older drugs, like metformin. There has not been a large clinical trial, but there has been a number of smaller looks at Metformin for prostate cancer. The general consensus has been very positive.
It seems to help control PSA, but as I said there hasn't been any controlled studies looking at prostate cancer disease progression or survival.
Given its minimal side effects and its probable PSA control it should definitely be discussed with your doctor.
I noticed that your husband has not taken any of the more traditional ADT drugs. I am sure that he made the decision to not use them, but instead to use DES. Perhaps, at some point in the future he might want to re-consider this decision and give them a try if the Enzalutimid fails.
I have written a number of posts about Metforim and similar re-purposed drugs on the Malecare Advanced Prostate Cancer Blog. Some of the posts that might interest you can be found by following these links:
advancedprostatecancer.net/...
advancedprostatecancer.net/...
advancedprostatecancer.net/...
Joel
Hi JoelT,
Thank you for the welcome. Ray has had an orchidectomy and used flutamide and bicultimide at different times over a 10 year span. Do you get a second bite at the cherry(so to speak) with these?? Then DES(12months), then Zytiga(13months), then Docetaxel every 2 weeks for 6 months(No benefit at all). I know that in the future that a decision will be made after enzalutimide failure, but would like somethings to add to the discussions that will come.
Carol
In reference to a second bite of the apple, sometimes you can get that second bite. For instance some men who have failed chemotherapy and moved on to another treatment do come back to chemotherpy and again have some limited positive responce. Possibly a second go at chemo might work? Also, possibly a return to Zytiga might be a possible alternative.
Additionally, absent from your list is Jevtana (cabazeltaxil). Jevtana is another chenotherapy agent approved for prostate cancer which could work. Response is not related to response to docetaxil.
Also, look into clinical trials. Clinicsl trisls can offer new, curting edge treatments that aren't yet available to the public. You can search for a trial at clinicaltrial.gov
Using Metformin would seem to me to require blood glucose checks- that would up the price since insurance probably wouldn't cover the cost of test strips if you're not diabetic. Someone posted that they were taking 4 metformin which could cause hypoglycemia in some people.
Under side effects on RxList:
"Metformin does not usually cause low blood sugar (hypoglycemia). Low blood sugar may occur if this drug is prescribed with other anti-diabetic medications."
-Patrick
Thank you, thank you... I am unsure what "pre-diabetic" is, so will research this. Ray did gain a lot of weight while on ADT, lost a little of it but mostly there still.
Carol
My own non-medical perspective is that pre-diabetes is a state where insulin sensitivity has been lost (insulin resistance). In diabetes, the pancreatic cells that produce insulin have burned-out to the degree that not enough insulin is being made. In pre-diabetes, the pancreas is still producing a lot of insulin, in a futile attempt to overcome resistance.
Since chronic glucose spikes lead to insulin resistance, fasting glucose can act as a marker. Doctors seem not to worry if it goes as high as 100, but Life Extension says that we should aim for below 85.
A surrogate for insulin resistance is the triglycerides:HDL cholesterol ratio:
1:1 ideal IMO
up to 2:1 is acceptable
>2:1 steps should be taken to reduce it.
Incidentally, in PCa, glucose as such is not a problem. But elevated insulin is. It's a growth factor for the cancer. IMO
-Patrick
Thank you for finding these videos. I am encouraged that there could be still more out there for Ray.
Carol2 - do yuo know where the cancer is? Lymph nodes, bones, visceral?
Visceral seems to have a bad name, but as I understand it, men do not die of organ failure (lung, liver...).
Bones- ribs(too many to count) spine, pelvis, sternum.
Lymph nodes, lungs.
Here we are late October and Enzalutamide is still king! PSA now down to 9.23 lowest since Dec 2010. Last few weeks pain has seemed to be an issue as well as nausea. Going back to specialist end November. Ray is incredibly lucky with funding as the drug company has him on named programme at no charge for us.
Carol
lung cancer 
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