Aspirin

[pjoshea13]

This post is prompted by a new study [B6].

I use NSAIDs maybe once or twice a year, in a bad year. I have never been tempted by prophylactic use of aspirin - even low-dose.

Aspirin has been around for well over a century (since 1899), so never needed U.S. FDA approval. Some say that if it were a new drug, it could never be approved. It accounts for a sizeable number of ER visits. The fathers of two friends who were taking baby aspirin daily, both ended up in ER hell in the middle of the night because of blood in their toilet bowls. For some, it can be rough on the stomach. & it can damage the kidneys.

But chronic use of aspirin is widespread & there are positive things to report.

How might aspirin help improve survival? As a NSAID, aspirin might extend life by reducing inflammation. However, I doubt that a daily low-dose aspirin is up to the job, since cancer is a seriously inflammatory disease. Also, if aspirin could lower inflammation significantly, it would likely lower PSA. This might lead to a delay in PCa detection, which would not be expected to improve survival. More likely, IMO, aspirin might improve survival by reducing metastases.

An issue with aspirin use, as with statin or Metformin use, is that the users might have a different PCa risk profile, unrelated to aspirin itself. Non-users might be expected to have less cardiovascular disease risk, but the population would also include those not able or disinclined to take aspirin. And while the user population would be expected to mostly contain men with cardiovascular problems, it would also contain cautious health-conscious healthy men.

[A] Metastatic PCa & aspirin use.

There is a widely held theory that abnormal coagulation assists in metastasis, & that micro-clots might even be essential for the survival of circulating tumor cells. Coagulation is a complicated process involving many factors, but there are two main events: (i) the aggregation of platelets followed by (ii) the acretion of fibrin. Aspirin inhibits the clumping of platelets at low doses.

It is often observed that men with PCa have a higher risk of cardiovascular disease. The PCa population might therefore contain a significant percentage of men using daily aspirin for CVD reasons. Men who began using aspirin regularly before PCa diagnosis might have the best chance of preventing metastases, if aspirin is indeed protestive.

However, it is possible that aspirin users might also be more inclined to have regular PSA tests, & might be diagnosed earlier. That could have an impact on treatment outcome, i.e. fewer mets.

[A1] (2002 - U.S. - Health Professionals Follow-up Study [HPFS] - Giovannucci)

A "cohort of 47,882" "2,479 new cases of prostate cancer were ascertained. Of these, 608 were diagnosed as advanced (extraprostatic) prostate cancer and 258 as metastatic prostate cancer. We found no association between aspirin use and total prostate cancer."

But: "For metastatic prostate cancer, we observed a suggestive decrease in risk among men reporting greater frequency of aspirin use. The multivariate relative risk of metastatic prostate cancer among men using aspirin 22 or more days/month was 0.73 ... compared with nonusers."

[A2] (2011 - Health Professionals Follow-up Study [HPFS] - Giovannucci - again)

"In a prospective cohort study of 51,529 health professionals": "A total of 4,858 men were diagnosed with prostate cancer during the 18-year study period. Men taking ≥ 2 adult-strength aspirin tablets a week had a 10% lower risk of prostate cancer ... For regionally advanced cancer, we observed no significant associations with aspirin use. For high-grade and lethal disease, men taking ≥ 6 adult-strength tablets/week experienced similar reductions in risk (HR=0.72 ...)"

"For lethal prostate cancer (M1 at diagnosis or the development of bony metastases or fatal prostate cancer during follow-up), we observed a significant inverse trend ... for increasing number of tablets per week whereby men who consumed less than two adult-strength tablets per week (equivalent to one baby aspirin daily) had a non-significant 3% lower risk of lethal prostate cancer ... that further decreased to 20% for 2–5 tablets a week ... and 29% ... for 6 or more tablets per week, when compared to non-users."

[A3] (2012 - Health Professionals Follow-up Study [HPFS] - Chan (& Giovannucci)

"This is the first study reporting on aspirin consumption after a prostate cancer diagnosis and its association with the development of lethal prostate cancer. We observed no association between post-diagnostic aspirin use and metastatic or fatal prostate cancer."

A "potential mechanism for reducing fatal disease may be through aspirin's anti-platelet effects to reduce blood–borne metastases. One may speculate that such metastases may have already occurred by the time of diagnosis, eliminating aspirin's potential effect through that mechanism."

"Our data do not support an association between aspirin use after a prostate cancer diagnosis and the development of lethal prostate cancer."

However, one might argue that there is benefit in preventing further metastases. IMO.

[A4] (2013 - Swedish Prescribed Drug Register)

(Amazing that the Swedes can track low-dose aspirin use!)

"Except for a borderline result in prostate cancer (OR ∼0.9 ...), aspirin use was associated with a lower rate of metastatic disease (ORs ∼0.6–0.8) {for colorectal, lung and breast cancers}."

"In summary, we found evidence that the use of low-dose aspirin in the year prior to diagnosis was associated with better tumour extent for colorectal and lung cancers, but not for prostate and breast cancers, and was associated with lower metastatic disease for colorectal, lung and breast cancers."

[A5] (2014 - U.S.)

"We hypothesized that {anticoagulant} therapy confers a freedom from biochemical failure (FFBF) and overall survival (OS) benefit when administered with radiotherapy in patients with high-risk PC."

"Aspirin use was ... associated with reduced rates of distant metastases at 5 years (12.2% vs. 26.7% ...)"

"On subset analysis of patients with Gleason score (GS) 9-10 histology, aspirin resulted in improved 5-year OS (88% vs. 37% ...)" !!!

[A6] (2015 - U.S. - African American men )

"We identified 289 African American men with prostate cancer who were treated with definitive radiation therapy to a dose of ≥7560 cGy."

{The authors tried to make this hard to read. "ASA+" means aspirin users. "DMPFS" is distant progression-free survival. "PCSS" = prostate cancer-specific survival.}

"ASA use was associated with a significant reduction in biochemical recurrences (hazard ratio [HR] 0.56 ...). The 7-year DMPFS was 98.4% for ASA+ and 91.8% for ASA- men ... On multivariate analysis, ASA use was associated with a decreased risk of distant metastases (HR 0.23 ...). The 7-year PCSS was 99.3% for ASA+ and 96.9% for ASA- men ..."

[B] Survival / Mortality.

Some metastases studies in section [A] also report on lethal PCa, but the following survival/mortality papers make no mention of metastases. Even so, lethal PCa is largely due to metastatic disease.

[B1] (2012 - U.S.)

"This study comprised 5,955 men in the Cancer of the Prostate Strategic Urologic Research Endeavor database with localized adenocarcinoma of the prostate treated with radical prostatectomy (RP) or radiotherapy (RT). Of them, 2,175 (37%) were receiving ACs {anticoagulants} (warfarin, clopidogrel, enoxaparin, and/or aspirin)."

"AC therapy, particularly aspirin, was associated with a reduced risk of {prostate cancer-specific mortality} in men treated with RT or RP for prostate cancer." "Multivariable analysis indicated that aspirin use was independently associated with a lower risk of {prostate cancer-specific mortality} (adjusted hazard ratio, 0.43 ...)"

[B2] (2012 - U.K.)

"Post-diagnostic low-dose aspirin use was identified in 52 % of 1,184 prostate cancer-specific deaths and 39 % of 3,531 matched controls ..."

"Compared with no use, patients with 1-11 prescriptions and 12 or more prescriptions had adjusted ORs of 1.07 ... and 0.97 .., respectively."

"We found no evidence of an association between low-dose aspirin use before or after diagnosis and risk of prostate cancer-specific mortality, after potential confounders were accounted for, in UK prostate cancer patients."

Prescriptions for low-dose aspirin?

{After 43 years in the U.S., people still ask me where I am from. But to the English, I now sound like an America. On a vacation in England in 2004, my wife wanted some low dose aspirin for the return flight. (Her brother & father had both died because of blood clots.) So we went into 'Boots, the Chemist" but could not find the stuff. I approached someone who seemed to be in charge, & explained that we were looking for Baby Aspirin. She sighed, & looked at me as if to say "Americans & their infantile euphemisms!." "You mean 75 mg aspirin!" If I had my wits about me, I would have said: "No, no - 81 mg aspirin.", which is the U.S. low dose. Anyway, she walked over to a locked cabinet & found what we needed. No prescription required.}

[B3] (2014 - Ireland)

Prescriptions again - but a different conclusion.

"Men with stage I-III prostate cancer were identified from Irish National Cancer Registry records, which have been linked to national prescribing data from the Irish General Medical Services scheme. Aspirin use in the year preceding prostate cancer diagnosis was identified from this linked prescription-claims data."

"In adjusted analyses, aspirin use was associated with a small, but non-significant, reduced risk of prostate cancer-specific mortality (HR = 0.88 ...)"

"In dose-response analyses, stronger associations with prostate cancer-specific mortality were observed in men with higher aspirin dosing intensity (HR = 0.73 ...) and in men receiving >75 mg of aspirin (HR = 0.61 ...)"

So the dose seems to matter. Note that a low dose is sufficient to prevent platelet aggregation, but an increasing dose would have more effect on inflammation.

[B4] (2014 - U.S. - men with nonmetastatic prostate cancer)

"... the Cancer Prevention Study-II Nutrition Cohort in 1992 or 1993 and June 2009. Aspirin use was reported at enrollment, in 1997, and every 2 years thereafter. During follow-up through 2010, there were 441 prostate cancer deaths among 8,427 prostate cancer cases with information on prediagnosis aspirin use and 301 prostate cancer deaths among 7,118 prostate cancer cases with information on postdiagnosis aspirin use."

Modest protection against lesser cancer, but:

"... among men diagnosed with high-risk cancers (≥ T3 and/or Gleason score ≥ 8), postdiagnosis daily aspirin use was associated with lower {prostate cancer-specific mortality} (HR = 0.60 ...), with no clear difference by dose (low-dose, typically 81 mg per day, HR = 0.50 .., higher dose, HR = 0.73 ...)"

[B5] (2014 - Canadian study using UK data)

Similar to [B2] - failed to find benefit.

[B6] (2017 - U.S. - Physicians' Health Study )

"In 1981/82, the Physicians' Health Study randomized 22 071 healthy male physicians to aspirin, β-carotene, both, or placebo. After the trial ended in 1988, annual questionnaires have obtained data on aspirin use, cancer diagnoses, and outcomes up to 2009 for the whole cohort, and to 2015 for PC patients."

"502 men developed lethal PC by 2009"

"Current and past regular aspirin was associated with a lower risk of lethal PC (current: HR 0.68 ... past: HR 0.54 ... compared to never users."

"In the survival analysis, 407/3277 men diagnosed with nonlethal PC developed lethal disease by 2015. Current postdiagnostic aspirin was associated with lower risks of lethal PC (HR 0.68 ...) and overall mortality (HR 0.72 ...)"

-Patrick

[A1] cebp.aacrjournals.org/conte...

[A2] ncbi.nlm.nih.gov/pmc/articl...

[A3] cancerpreventionresearch.aa...

[A4] ncbi.nlm.nih.gov/pmc/articl...

[A5] ncbi.nlm.nih.gov/pmc/articl...

[A6] ncbi.nlm.nih.gov/pubmed/264...

[B1] ncbi.nlm.nih.gov/pubmed/229...

[B2] ncbi.nlm.nih.gov/pubmed/243...

[B3] ncbi.nlm.nih.gov/pubmed/243...

[B4] ncbi.nlm.nih.gov/pubmed/253...

[B5] ncbi.nlm.nih.gov/pubmed/254...

[B6] ncbi.nlm.nih.gov/pubmed/281...

[bdriggers]

Very timely. The Proton BOB need Letter just had an article on Aspirin.

[bdriggers]

Aspirin: Cancer Prevention, Heart Protection Colorectal Cancer

There is compelling evidence that aspirin

reduces the risk of colorectal cancer (CRC).

Researchers conducted a series of cohort

studies over the past couple of decades. In

two population-based cohorts (the Nurses

Health Study, comprising 121,700 female

registered nurses, and a parallel cohort comprising

51,539 men) they found that those taking aspirin had a lower risk of developing CRC over time. More specifically, they concluded that taking a daily aspirin consistently for six or more years reduced the risk for developing CRC by 30 – 40 percent. Other studies have shown short-term use of aspirin also reduced the risk of a recurrence of CRC when patients began an aspirin regimen after being treated for the disease.

Prostate Cancer

Another study has shown that regular aspirin use is associated with a slower rate of prostate cancer progression and a reduced risk of dying from the disease. According to one researcher, “Men with prostate cancer who took aspirin regularly had a 39 percent lower risk of dying from the disease.” However, aspirin use did not measurably reduce the overall incidence of prostate cancer. It also did not prevent high-grade cancers or locally advanced prostate cancers.

Heart Disease

In 2016, the USPSTF recommended the use of aspirin for prevention of CRC and heart disease. They recommended: “People aged 50 to 69 years who have a greater than 10 percent 10-year risk for cardiovascular disease (CVD) and who do not have higher risk for bleeding should consider taking low-dose aspirin to help prevent CVD and CRC.

More Benefits

Research has also shown aspirin can reduce the risk of many other cancers. In eight trials involving 25,000 patients, aspirin reduced the incidence of cancers of the esophagus, stomach, pancreas, lung, kidney, bladder and blood.

The Downside

There is a potential downside to the use of aspirin. It increases the risk of gastrointestinal (GI) bleeding. One study showed up to a two-fold increased risk in bleeding. Note that high-dose aspirin is associated with higher GI bleeding risk than low-dose and bleeding risks can be mitigated with certain medications.

[bdriggers in reply to bdriggers]

Patrick,

This is from the news Letter.

[Wildandcrazybob]

Thanks once again, Patrick. Your efforts and willingness to share research is undoubtedly widely appreciated. I have taken 81 mg daily for a decade or more. No advanced stage PCa yet...

[Hidden]

Those of us that were radiated have a much greater chance of bleeding from scarring. It's not a very good idea to take even an low dose aspirin. I know, I've been there.

[Neal-Snyder in reply to Hidden]

Were you always taking the aspirin with a meal, Joe?

[Hidden in reply to Neal-Snyder]

Yes I did. I took my Zytiga first thing, and the remainder, after I ate lunch or dinner. Not much, Flomax, Cymbalta, Prednisone, and Protonix, and the aspirin. In my particular case, I had bad cases of Cystitis and Melena, due to the radiation.

I went in the hospital for the Melena, after a CT Scan, they found my bladder distended. I was bleeding everywhere down there. Well, both ends anyway. This was about six years after the rad. It was awful painful. And, actually, I had a crew of idiots from the get go, who Dx'd the bladder, but never treated it.

Sorry for the rant, Joe

[Neal-Snyder in reply to Hidden]

Sorry to hear taking aspirin with food wasn't sufficiently protective. I have no problem with brief, understandable rants, Joe.

Neal

[Hidden]

I have been dismayed by the number of doctors who wanted me on prophylactic aspirin "just because", let alone since my PC returned, given how many thousands of people NSAIDS, incl aspirin, kill every year and given how few days it takes (2 or 3) for enteric-coated baby aspirin (or low-dose ibuprofen) with meals and on or off a PPI to double me over in pain. If it's not aspirin, it's statins because our pill-pushing doctors are told our cholesterol has to be below fricking TWO or whatever the hell Big Pharma's latest magic number is. Pardon the rant, but it's 2:10 AM and I just got up to vent at the fact that so few doctors are worth a $#!+ anymore. MY CHOLESTEROL IS EXCELLENT AT 220, you bastards, men our age live LONGER with elevated cholesterol and women even longer yet, aspirin hurts me FAR worse than any of my four cancers ever has, I can and often do over-rev your damned $5,000 elliptical machine for ten minutes every other day without ANY cardiovascular glitches, and my systemic inflammatory marker (ultrasensitive CRP) is almost undetectable, and I do all that with ordinary nutrition and exercise, not damned drugs, thank you very much. Keep your damned aspirin and statins away from patients who suffer or don't benefit from them and save them for the much smaller group of patients who clearly and individually DO benefit from them for very specific, proven reasons. At the very least, NEVER tell a pt to "start taking an NSAID or a statin every day and call me in three months", as 8-10 doctors have told me to do. SOME OF YOUR PTS MIGHT ACTUALLY DO SOMETHING THAT DANGEROUS.

As for "Another study has shown that regular aspirin use is associated with a slower rate of prostate cancer progression and a reduced risk of dying from the disease. According to one researcher, “Men with prostate cancer who took aspirin regularly had a 39 percent lower risk of dying from the disease.” However, aspirin use did not measurably reduce the overall incidence of prostate cancer. It also did not prevent high-grade cancers or locally advanced prostate cancers ..."

OF COURSE: We have the same dilemma with many anti-PC drug protocols: they too-often kill us by causing diabetes, heart disease, hip fractures, and more so that we die WITH rather than OF our prostate cancer, and that goes into the win column with the damned drug companies. They don't point out that even though our disease doesn't "progress as rapidly", we still don't LIVE one day longer.

Speaking of diabetes, you tell us sadly after all your drugs fail to resolve our Type II diabetes that we're just gonna have to lose some feet and lower legs and eyes and freaking DIE because "If drugs can't cure it, nothing can". Tell that to the thousands of advanced, DYING Type II diabetics who have been completely cured within weeks and without ANY drugs by eating less %*@^ing CRAP manufactured by man in factories from what was once actually FOOD! It was CRAP that gave them the T2DM in the first place, and removing the crap can reverse it without ANY of those nasty drugs.

I'm dyin' ... probably literally ... to read my newest book, Dr. Malcolm Kendrick's "Doctoring Data: How to sort out medical advice from medical nonsense". Will it back up the many accusations we've seen in peer-reviewed literature about pill-pushers, or is it just disgruntled hype riding the bandwagon? Reviews are about 140 to 2 in favor of the former, and they say it's also fun to read. How often does anyone say THAT about a medical book? Besides, I could use a laugh, as I'm THIS close to firing my medical oncologist just days before I'm expected to choose whether to destroy my mind and body with chemotherapy just in case it might prolong my heartbeat by the very length of time the drugs are HIGHLY likely to destroy our QOL. Two phone calls this weekend and one this Tuesday will determine whether I have to start from scratch with a new med onc in the hopes of finding one who will actually respond to repeated treatment-critical phone calls within two frigging weeks. Enteric coated baby aspirin would have me literally bawling in pain (been there, done that) and thus likely passing bloody stool within those two weeks.

Aspirin, like all NSAIDS, is not candy. They account for 11% of all preventable drug-related hospital admissions. Each year more than 100,000 patients are hospitalized for NSAID-related GI complications alone, with direct costs ranging from $1800 to $8500 per patient per hospitalization. Moreover, it has been reported that 16,500 persons die annually from these complications. In the elderly, the medical costs of adverse GI events associated with NSAID use likely exceed $4 billion per year.

[Neal-Snyder in reply to Hidden]

I.B., please post your opinions on & takeaways from this book on our site after you read it. Thank you very much!

Neal

[Hidden in reply to Neal-Snyder]

Will do, but don't hold your breath. My local medical oncologist just moments ago -- after I've been calling for two weeks about it -- refused to even check my T and PSA to determine whether my last Firmagon injection is working before continuing my ADT or beginning chemotherapy, which could create grave harm if it is not working. Tomorrow, for example, my tasks will have to include hand-carrying the most scathing letters I can generate to the Patient Advocate and CEO of the area's biggest hospital system. If those fail to change their ADMITTED institutional policy of non-responsiveness, I will have to escalate this to the state medical board.

JUST TO GET A GD PSA AND T TEST!

I expected and got the same BS from the VA. That's why I no longer even tell the VA that I have cancer: they do absolutely nothing about it, despite having removed my prostate 12 years ago. WTH hell good is paying cash for FOUR federal government insurance policies doing me?

The lefties in this country got the government-managed healthcare insurance they wanted, and it's killing us.

I'll get very little sleep tonight, but will tear the arms and legs off some gym equipment tomorrow to calm down before writing those complaint letters. Here I thought I was through having to manage my own damned cancer care!

[Neal-Snyder in reply to Hidden]

I.B., I can't tell you how very sorry I am. This makes me VERY, VERY pissed off, so I can imagine just how rough this is for you, & the gym equipment.

Please don't blame the lefties. The GOP has been starving federally-funded programs (except defense & national security) to the best of their ability for a long time. (That very definitely includes the VA.) Even so, the people you're dealing with are total assholes!

I'm a Kaiser member, but I've been on their Senior Advantage (Medicare) program for 10 years, & I get whatever I need. My doctors order it & no one 2nd-guesses them. Because my PSA has been going up on Zytiga (after 2 1/2 years), my med onc changed my PSA & T tests from every 90 days to every 30, & my bone & CT scans from every 6 months to every 3 months.

My primary care physician (PCP) is the kindest, most responsive & thorough doc I've ever known, & he refers me to specialists as needed. They've usually been really good.

After my spinal cord compression from a PCa tumor, I had emergency surgery with a spine surgery expert who cared enough to fight for an OR for me (my wife happened to walk down the hall & heard him on his cell phone). He got the OR. A few days later, I was moved to a rehab program for 4 weeks (I had to start learning to walk again). Wonderful doctor, nurses, facilities, physical & occupational therapists, secretaries & fellow patients.

I got to choose a wheelchair to take home, & got one that was fast, responsive, & fit through my small bathroom door. Then I had in-home PT & nursing visits for a while, & then outpatient PT at my hospital. This is how it's supposed to be. Obamacare is not the problem, unless it bothers you that millions more low-income people have health plans now.

Where are you? Is your med onc the only one available to you? I changed my PCP a few times before I came found my wonderful guy (thanks to a tip from a nurse). I wanted someone who would answer emails within 2 days, which is Kaiser's policy. My guy is extremely fast, helpful & provides excellent explanations.

IF YOU HAVEN'T SENT YOUR LETTERS, PLEASE cc YOUR CONGRESS PERSON. Whether or not you have, if you don't get a positive & timely response, call the Congress Member's office, or walk in, or make an appointment, & see if they'll help you. Or send a letter & then contact them. It's most likely that you'll deal with a local office staff member (usually an attorney) but that's who you need. I was an attorney for the state of CA, & if someone had a problem with me, they often contacted a state politician's office, & we heard from them & had to respond. If I got a call, it was from a staff member. Your situation, I believe, should get people quite concerned & acting strongly on your behalf. You should write to the medical board too, but political pressure could get you what you need faster.

What's your first name?

Neal

[Hidden in reply to Neal-Snyder]

I wasn't referring to O-Care in particular (there aren't enough keys on my keyboard to cover my highly informed opinions on that) but to the whole concept of government-managed taxpayer-funded health care, aka by definition socialized medicine.

Thanks for the contact tips. When I write important letters on consumer issues, I like to cover every base I can think of. I have been waging consumer -- THIS consumer -- battles for >50 years with many entities ranging from a neighbor's lawyer to the CEOs of some blue-chip corporations (never mind the many general officers my wife and I have been toe to toe with in the Pentagon, the field, and the federal courts.) My own win/lose/tie record runs very close to 40/1/2 ... and I'm an engineer, not a lawyer. I've beaten many a personal and corporate attorney simply by shoving facts in their faces they know they cannot defeat economically. I've received numerous kudos, medals, public acknowledgements, and cash for myself and others from several commanding officers, a congressman, the CEO of the world's largest mortgage firm, and many more sources. I've won battles worth 9 figures to the taxpayer, and my wife can add three zeroes to that for some of her fights.

Thanks for stirring my pot. Banging out this response has strengthened my resolve to avoid cancer treatment-induced cognitive impairment at almost any medical cost (one exception will be whatever ADT induces, which includes a 47-68% chance at significant CI). Not only do I enjoy the HELL out of defeating these bastards (and even the well-intended but simply wrong), but that and the research I've done to do it have garnered immense satisfaction, many career brass rings for myself and others, 6 figures in cold hard cash in my own pocket, many cancer and other health victories, and retirement almost 30 years ago at 45, just for starters.

My point: I. Don't. F. Around. I hit these mofos with up to five barrels as appropriate for each case ... facts, logic, laws, common sense, and hard copies of letters ready to go to their superiors to show I mean business. My concern in this present case is that this firewall between doctors and patients appears to be the official, unapologetic, business-model-driven policy of a five-state, nested, nebulous healthcare conglomerate topped by Providence Health & Services that forcefully bought out most eastern WA hospitals and small clinics two years ago. I've noticed that this oncology clinic head I can't access -- the oncologist in whom my life is currently entrusted -- is also on the board of every hospital in the region, and they have forced virtually every medical oncologist I can find into The Borg. Resistance is apparently futile.

The more $#!+ I see like this, the less interested I become in adding the 10-20 years of vigorous longevity Leibowitz of Compassionate Oncology is adding to many of his PC patients. I spoke at great length just Sunday with yet another, local, man who was given a year to live by Seattle's top oncology research center. He had very minimal SEs even from ADT and chemo, now travels all over the world on vacations, gives proclaimed lectures at universities, and has all the energy and vitality he wants. The primary anti-cancer drug he occasionally uses now is very high doses of testosterone. His secret? He didn't like being told he had a year to live and that his only choice was a Can of Standard ADT and a Can of Standard Chemotherapy, so he called Leibowitz, to whom he credits his life from that day forward.

That was 18 years ago, and I've talked at length the past two weeks with many of Leibowitz's patients with similar victories.

I've read many times that the VA has received all it has requested and more for well over a decade, but its budget goes out for only a year or two so it doesn't allow for even obvious surges, let alone surprises. I'm firmly convinced its main problem is total, brainless incompetence at every level. I've met many very impressive worker bees in the VA, but they are matched man for man by useless, often even harmful, medical providers. (e.g., they lost ALL my medical and disability records; if I hadn't kept my own duplicate files, I would no longer exist in the VA system. Then three years later they did it again.) I've gotten personal, face-to-face, one-on-one sympathy and encouragement from THE Chief of the VA, from his Washington, DC deputy in charge of Veterans' Benefits, from the director of my nearest VA hospital, and from teaching hospital medical department heads who work with the VA system on Fridays; all that and $1.85 plus tax would buy me a small cup of Starbucks' cheapest coffee ... if I drank coffee.

Mike

(I'd use my whole name here if I hadn't been tracked and libeled across the internet before even in moderated forums.)

[Hidden]

Whew, candy.

[Hidden]

Does all this discussion of aspirin effects apply to other NSAIDS like aleve or meloxicam? I was on a low dose aspirin regimen as a stroke preventative for my a-fib. Then I would just slam an aspirin as needed -- when I was in an a-fib episode. I do take aleve often (but never more than once a day) for assorted aches and pains like toothaches or hip bursitis. I relented and now take the low dose statin (lipitor). I did read some claim that statin use reduces the risk of developing prostate cancer by a very significant amount. I didn't start on statins until I was already diagnosed. On another subject -- I saw the admin's admonition on the practice of touting specific treatments or doctors? Did I read that right? Isn't that what we do here?

[pjoshea13 in reply to Hidden]

Although NSAIDs are grouped together under that name, they work in different ways. Each would have to be researched individually with respect to PCa. Aspirin inhibits the aggregation of platelets - the first step in coagulation. It may thus inhibit metastasis. I can't speak for the other NSAIDs right now.

There is a good case to be made for statins. First, the PCA stats suggest benefit. Second, solid tumors accumulate cholesterol. Third, during ADT, PCa can start making androgens from stored cholesterol. Fourth, PCa cells can even synthesize cholesterol if the supply is scant. i.e. we have reason to inhibiit synthesis, & men on statins do seem to benefit. Otherwise, in CVD, I think that statins are a poor solution to the problem, & many do not have a CVD problem.

Touting? I feel uncomfortable when someone is enthusiastic about a therapy that I feel has no PCa track record.

With supplements, I present none of them as cures. But there is a body of literature on PubMed - quite unlike any other cancer - where we can discover the cell signaling pathways that are inhibited in PCa. Posting such is not touting.

Dr. Myers has evolved as a fan of some supplements, while warning men to stay away from these "untested drugs".

For those who ridicule their use, I can only point out that many drugs came from the natural world:

- Taxotere is an analog of Taxol, an extract from the bark of the Pacific yew tree

- Metformin from the French lilac or goat's rue

- Lovastatin (first statin) from red yeast rice

- Aspirin from willow tree leaves has been used for over 2,000 years.

& so on.

Search PubMed for <"curcumin analog"> & you get 121 hits. When Pharma hits on a winner, it will likely cost thousands of dollars for a month's supply.

-Patrick

[Neal-Snyder in reply to pjoshea13]

Great comment, Patrick.

Are you aware of any research comparing men who took aspirin with food vs. without, regarding GI complications?

[Hidden in reply to Hidden]

Yes, all this discussion of aspirin effects applies to other NSAIDS like aleve or meloxicam. An NSAID is an NSAID in an NSAID ... they can differ a bit, but are pretty much alike in that just like cigarettes, junk (manufactured) food, and the American diet in general kill us by the millions when abused. Simply being legal over the counter does not make stuff safe. MUCH of the chronic inflammation and/or acute injury pain that messes with so many hundreds of millions of lives can be powerfully mitigated by dietary tweaks without resort to NSAIDs. In fact, NSAIDS (and/or ice) is well documented to retard and/or even permanently inhibit acute injury healing. I've not studied baby aspirin in depth because I can't tolerate it, but the only two benefits I've seen for it are reducing colon cancer incidence and reducing the odds and lethality of second heart attacks.

The research I've found on whether statins boost the efficacy of ADT is inconsistent. Even the most favorable recent report on that added that the data are not persuasive enough to warrant taking a statin just to prevent, let alone treat, PC. Thus, considering the harm statins do to so many people including myself (dramatic pain in every muscle and joint in my body for a year after I quit the stuff), I'm not going to take it again unless new, very solid evidence fixes its problems and changes my mind. If nothing else, studies have shown that the pain I experienced is all but guaranteed for a subset of people every one of us here should be in to protect our bones, fight our drug side effects, and improve our QOL: anyone performing serious strength-building exercise. Statins almost ended the careers of a pro football team whose members took them for lipids control in one study.

Even if cholesterol were the health threat Big Pharma wants us to believe it is, it can be manipulated very easily with nutrition. For 20 years I asked at LEAST 15 physicians what to do about my REAL cholesterol problem: low HDL (30s) and very high triglycerides (200-400.) The ratio of trigs to HDL is an infinitely better heart disease predictor than total or LDL chol, and it should be <2 or 3 or something like that. My ratio was 10 or 12 ... bad. EVERY doctor, including two idiot cardiologists, mandated statins, denying that they had any downsides.

Freaking, lying, IGNORANT, bought-and-paid-for, FOOLS. Bought a book, tweaked my diet, easily, quickly, and apparently permanently dropped my trig to 50 and upped my HDL to 85 for a ratio of 0.6 along with numerous other health benefits. Newer, more sophisticated testing this year told my most sophisticated doctors that my heart is absolutely fine for at least THIS century, as one of them jokingly put it.

Docs including those cardiologists were amazed but still said my LDL was too high. Freaking, lying, IGNORANT, bought-and-paid-for, FOOLS. 1) LDL by itself is meaningless. 2) There are MANY kinds of LDL. 3) We can tweak our diets to manipulate it among those types without all the stupid drugs with their nasty and sometimes VERY serious SEs. I bought a book, tweaked my diet in another manner, and completely changed the very nature of my LDL into the harmless, big, puffy LDL-A form along with several other health benefits. SHEESH, docs ... RTFM.

[erjlg3]

Had three different docs tell us that an 81 mg is just as effective EVERY OTHER DAY as every day. Said it's easier on your tummy too. Heart attack and strokes run in my family so I've been taking mine.

[j-o-h-n]

I don't know why... but aspirin gives me a headache....

j-o-h-n Monday, 02/20/2017 9:12 AM EST

[bldn10]

FWIW I've been on naproxen for 40 years and low dose aspirin for probably 15 w/ no apparent issues. I do monitor relevant markers.

[Hankster]

The only time I take an NSAID is if I have a bodyache usually from working hard in the gym. If you find a diet that works for your metabolism that is low in carbs it is naturally anti inflammatory. Exercise is a must to work against the side effects of the various drugs we take to reduce testosterone. Your body will adjust cholesterol to its specific needs. Some supplements like tumeric reduce inflammation.