Advanced Prostate Cancer
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Metformin

Has anyone been prescribed Metformin to treat advanced prostate cancer? I just met with a new Oncologist and they were surprised that my last Oncologist did not recommend it. It’s typically used by folks with diabetes but has been shown to slow prostate cancer growth.

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I had gotten down to PSA of 0.7 from 840 and asked me MedOnc for Metformin. I do 500mg twice/day and PSA got down to 0.2 - 7 months later. There's sufficient data/research about it and it is pretty cheap and well tolerated. Good luck

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Thanks for the feedback. It sounds promising.

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Thank you for sharing the info about Metformin. How were you able to reduce your PSA from 840 to 0.7? Was your PSA this high because of bone metastasis? How long did it take to reduce it?

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Started ADT(Lupron/Casodex) in Jan 2015 and did 15 Taxotere sessions with last chemo on 12/17/2015. Only Mets to L side ureter lymph nodes, had a 65 gm median lobe on the prostate. Nadir at 0.2 in 2016 and started to rise - started Ursolic Acid/Curcurmin/Resveratrol U of T study showed that combo worked. Got down to 0.1 - then stopped ADT after 30 months on 03/31/2017 - to not go castrate resistant. PSA rose to 3.3 - did a month of Casodex and dropped it to 3.0. MedOnc gonna try and do a 150mg/day Casodex monotherapy and then Lupron again in the future.

Randy

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Are there any side effects? Does it affect blood sugar? Mine is normal and wonder if it would then go low?

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Patients may lose weight and hypoglycemia is possible, but that can be solved by eating a bit more lean protein that will slowly turn into blood glucose. The mechanism is unclear, but research is ongoing. It reduces insulin, which may be tied to cancer.

harvardprostateknowledge.or...

ncbi.nlm.nih.gov/pmc/articl...

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I do not believe it impacts blood sugar. It can have GI related side effects for some. Some get loose bowels while others, ironically can become constipated. Some folks can become a bit "foggy." Make sure you take it after eating and with ample water. I take 2 500 mg tablets twice a day. I had some of the foggy side effects at first so I worked my way up slowly, even cutting the tabs in half going from 1000 to 2000mg a day. That worked. My comments are not intended to provide specific medical advice, just my own experience. (IMO)

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I take 1000 twice a day based on research Patrick O'Shea reported on this site. Have you read something supporting 2500 a day?

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Sorry, there is a space in there, it should read 2 --- 500 mg tables twice a day

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Yes. My husband's been taking it for years for advanced prostate cancer.

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My dad has been offered it on a clinical trial in the UK. Where are you based ewhite999? I'm hearing more and more about it being used to help treat prostate cancer and that it is very well tolerated with minimal side effects.

All the best,

Clare

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I'm in New Jersey

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Hi, my husband has had radiation, chemo, Lupron shots, all sorts of hormone drugs, casodex on the beginning worked for almost nine years, after chemotherapy on Zitaga, dr. Took him off of it.the Zitsga did not work. PSA kept fixing. Just found a lymph node is involved. Never put on Metformin??

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Metformin research showed probable PCa benefit at least 6 years ago. My GP wouldn't give it to me, but my integrative medicine guy did.

A 2014 Swiss study [1] caused Dr. Myers to finally embrace it. "Snuffy" made a video [2]. & then another [3]. PCa patients may know more about it than their doctors right now. It probably should be prescribed at diagnosis - or earlier. Life Extension [LEF] once said that most adults should be using it.

Note that the dose you want to work up to is 2x500mg twice daily - but you need to ease into that since the gut needs to get used to it.

I know men who prefer berberine because it is not a prescription drug. There are studies that compared the two (but not for PCa). The inspiration for Metformin was a chemical found in the French lilac, used in folk medicine for centuries - so too berberine.

After telling men that they should be on Metformin, & having doctors refuse the men who asked, LEF suggested the alternative of an AMP-K activator [4] [5].

This is an important topic IMO.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/244...

[2] askdrmyers.wordpress.com/20...

[3] askdrmyers.wordpress.com/20...

[4] swansonvitamins.com/life-ex...

[5] swansonvitamins.com/swanson...

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Patrick,

I'm definitely thinking about adding metformin. My MO refuses to prescribe it, so I'm left with getting it thru my GP, or get these alternatives you mentioned in 4&5 links. If the active ingredients are the same, would you still have a preference?

Shayan

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Shayan,

We don't really know the full Metformin story.

Both of the alternatives I mention are AMP-K activators. There is plenty in the PCa literature that associates AMP-K inhibition with aggressive disease. I would probably hedge my bets & use both products.

But do all of the Metformin cancer benefits derive from AMP-K activation? As yet, no-one has claimed that.

A thought for those not on the full 2,000mg Metformin: perhaps berberine could help complete the dose.

-Patrick

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Thanks Patrick -

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We have 500 mg prescribed for another month, and then we are left to our own devices. Not in a hurry, but I’m guessing twice daily 500 mg isn’t a bad idea, although Leswell’s weight is normal, and he is not diabetic. It’s an important topic in our opinion, too.

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Hi! Yes and no. I’m a patient, not a medical professional, so take this (like all other comments you read) with a grain of salt. My oncologist said he couldn’t prescribe Metformin to treat my prostate cancer, but he told me to see if my family doctor could do it since I am borderline type 2 diabetic. He gave me the Rx for metformin. I’ve been using it now for about a year (500 mg 3/x day) as an adjunct to my Lupron/bicalutimide ADT. I can’t say for sure exactly how much is attributable to the metformin v.s. Just the ADT, but my PSA has remained undetectable, both prior to and with the addition of, Metformin, so something is working. I believe studies have proven the efficacy of Metformin as an adjunct to ADT, and you can Google an abundance of articles on it, so there must be something to it. Plus, it is very well tolerated, has few side effects, and may help counteract the weight gain from ADT. You pretty much have nothing to lose unless you’re one of the few people who can’t tolerate it. It’s worth giving it a try. Best wishes.

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Yes I take 4000mg per day.

I think very few oncologists use it.

I got started on it with Dr. Myers in Virginia.

Who is your oncologist and where is he located?

Anything else interesting that he is prescribing you?

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Is there a research basis for going above 2000 mg daily?

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1. Correction, I am taking: 500mg extended release tablets 4 x per day

I would ask that question to patrick here.

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That's the right total. It's supposed to be taken with food. I find it most convenient to have the Rx changed to 1000 mg & take 1 with breakfast & 1 with dinner.

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My Dad is at The Royal Marsden hospital in London under Dr Vincent Khoo. This is one of the UK's leading cancer hospitals.

At our last appointment, I asked whether it was advisable for my dad to go on metformin but Dr Khoo but as the trials have not been concluded he would not recommend anything. It's frustrating because my dad will not go outside their protocol. (He is stage 4 with mets diagnosed September 2014, has been through hormone therapy, chemo and currently on enzalutamide.)

There is a private oncology clinic in London called Care Oncology Clinic. They recommend that patients take:

Metformin

Doxycycline

Atorvastatin

Bendazole

Has anyone looked at this or been to or heard of this clinic? I would value your input on this.

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I tried Metformin for 5 months--no effect on PSA but got very bad diarreah(sp) and it persisted even after reducing dosage and then increasing. did reduce my weight--but had to stop.Had no effect on blood sugar(borderline high)

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Most of the oncologists prescribe only approved cancer drugs in treating cancer. They don't prescribe vitamins, supplements, and food items which have not gone through long drawn trials. Same procedure is followed by the Medicare and Insurance companies. As a result even if a miracle cure for PCa emerges in the process of scientific research we will only have the pleasure of reading the research news articles but it will take many years for the drug to come from the bench to the bed side or may even vanish into thin air due to the upheaval of medical and political bureaucracy. But there is a handful of innovative oncologists like Dr.Charles Myers who go out of the box and treat patients with a curative intent and they judiciously select several other drugs as well, tested in random trials to combine with their main treatment protocols to achieve synergy. Metformin which is a commonly used drug for diabetic patients which is also very cheap has been found to be effective in retarding the progression of PCa. It should not be misconstrued that when your PSA is rising, Metformin can arrest it! I have been using a dose of Metformin - 1000mg ( 500x2 ) daily for the last 3 years. Whether beneficial or not, from a cancer point of view, it has no side effects. And I use it.

Sisira

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Further, of recent times I have read several very informative posts here by our Research Fellow Patrick ( pjoshea 13 ). One titled " Metformin inhibits SUV39H1- mediated PCa migration " This article explains the action of Metformin on PCa. I have read several similar articles elsewhere supporting such views.

Sisira

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sisra et al: Probably one of the reasons conventional oncologists (and other MDs) are hesitant to use vitamins, etc., is that the effects and the interactions with the prescribed standard drugs are not known. This does make their job harder.

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Correct.

Sisira

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I’ve been taking 500 mg twice daily since 2015 as prescribed by Dr Dattoli who treated Dr Myers w IMRT. I guess it’s helped as I’m stage 4 with Psa of <.1. No SEs I’m aware of.

Bob

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I've been taking it for almost 4 years now per Doctor Myers and now Dr. Sartor. My local onco agrees with it as well. I take 1000mg twice daily. Publix supermarket pharmacy doesn't even charge for it.

Ed

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Has any one been treated for one lymph node?

Zitaga and Xtandi stopped working for my husband before and after having chemo. Never heard of

Metformin?? Will ask oncologist?? As it stands now last PSA was twenty,,before chemo it was two hundred fifty eight.

Best wishes to all of you.

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Ronnie, I recently had 8 sacral LNs removed robotically and my PSA dropped by 50%.

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For years, I've been diagnosed as "pre-diabetic" or a more specific term they like is that I am "insulin resistant". I also have prostate cancer. So Metformin for me was a perfect drug.

Everyday, your liver produces glucose. Sometimes to much. Metformin works by making the liver produce smaller amounts of glucose every day than it normally does.

Metformin also INCREASES the bodies sensitivity to insulin, making your cells less insulin resistant. It also decreases the amount of glucose that is absorbed from food a person consumes. In taking Metformin, your cholesterol may also drop and you may experience weight loss, as in some people, Metformin may reduce the appetite. It did not affect my appetite.

In all the reading I've done on Metformin and people taking it who have prostate cancer, the information I read related that it primarily works on people who are either diabetics, per-diabetic or in my case, insulin resistant. I could not find a report that indicated that Metformin was beneficial to people with prostate cancer who do not have a diabetic blood glucose or insulin resistant problem, though admittedly I didn't pursue it because that didn't apply to me. I'm not a doctor and can not specifically tell you if Metformin will be beneficial to you without one of these conditions present.

Cancer cells feed off of glucose, so a diabetic or insulin resistant person with high blood sugar levels would benefit from lowered blood sugar levels where as a person with normal levels "may" not. You may want to chase this specific topic down more if your not diabetic or insulin resistant and want to take Metformin to reduce your PSA.

My PSA was <0.10, undetectable, for almost 5 years. It popped it's head up about 6 months ago to 0.2%. I did more reading and found several studies and articles that my diet may be what is flaming these prostate cancer cells. Red meat, chicken, dairy products ALL seem to flame prostate cancer cells. The answer to that question was easy. Go on a Vegan or vegetarian diet. I know, that sounds awful. But it wasn't at all. There are so many new tasty products out there today that it's really not that hard to cut ALL meat and dairy products from your diet. I also feel better and my energy levels have increased.

Results of diet change alone before I started taking Metformin: A PSA test 3 months later and my PSA disappeared again to <0.10%, undetectable. That diet alone, not Metformin, reduced my PSA levels to back where they belong, undetectable! However, if you do have a diabetic or insulin resistant problem, I personally also suggest Metformin.

Side effects. Good possibility. My Endocrinologist (diabetic doctor), upon my request, put me on Metformin. The standard high dose of Metformin for an adult is 2,000 mg per day. I believe the max dose is around 2,450mg per day.

The usual dosage advice is 500mg once a day the first week, 1,000mg a day the second week and 2,000 mg the third third. If your doctor prescribes 500mg tabs of Metformin that are NOT Extended Release, I personally would suggest you modify to 500mg first week, cut the tablets in half and take 750mg second week, 1000mg third week, 1,500mg the third week and then to 2,000mg the fourth week. Ease in to it more. You should never cut any Extended Release pills in half.

I was doing fine with no side effects until I moved to 2,000mg a week (4 500mg twice a day) and then all of the sudden, my GI/stomach did NOT like this drug. I was slightly nauseous ALL day and night, more an annoyance and feeling sick than anything else. I then reduced my weekly intake back to 1000mg a day and worked my way back up on the above schedule and

it's really worked for me. Your stomach does condition itself to this drug but it seems to take time.

Personally, for me, I can not stress enough that you MUST take Metformin with food.

This drug on an empty stomach can play havoc with your day. For me, it wasn't so important to take your doses every 12 hours, but more important to take them with breakfast and again at dinner time. I like to eat 1/2 my meal, take my Metformin, then eat the other half of the meal. Stomach issues were being resolved.

Also, once on 2,000mg a day, I had my doctor switch me over to 500mg coated EXTENDED RELEASE tablets. This allowed small amounts of Metformin to be released into my GI tract throughout the day and also helps eliminate the troublesome and common stomach issues.

It's just easier on your system and is just as beneficial as regular Metformin tabs.

Also, to get the best results of Metformin, you MUST include a healthy diet and exercise. Taking this medication while sitting on the couch eating steaks and sugar filled food greatly reduces its effectiveness. And like I said earlier, eliminating all the meat/dairy from my diet to a easy Vegan or even vegetarian diet reduced my PSA all my itself, even before I started taking Metformin.

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Hi Hunters

Thanks for feeding us on your personal experiences.

I hope I can learn from it.

Currently I am combining my treatment with some thing else: I do eat/ feed liberally and my psa is now in mid 20+ , It very close to double in 2 months. My last CT scan shows stable.

I will put Metformin in my wish list.

Roland

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I knew my med onc wouldn't prescribe it since it hasn't been proven sufficient for him or his colleagues. So I asked my primary care physician & showed him the research findings Patrick O'Shea reported. This got me first 500 twice a day, & then 1000 twice a day. I had PSA drops both times, & didn't notice SEs. It's good that your new med onc is "with it!"

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Yep---at my insistence.

Nalakrats.

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Hi Nalakrats

I was surprised you are in favour of Metformin which is s non cancer treatment medication before.

Now I like to question to you about green tea.

My research indicates it can cure prostate cancer.

So lately I have been treating myself green tea and in doing do I have yet to double my psa reading although it is close.

Roland

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No it cannot cure cancer, the molecules of importance are too large and when broken down in the stomach---they are useless. I only have 6 Publication in Tea Chemistry.

Nalakrats

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Hi Nalakrats

I am quite sure you are correct,

Do you ever wonder why I am confident about what I am doing.

It is about the ph effect.

If you been researching for so long it would have agree on high ph (the Alkaline factor) in slowing the growth of cancer.

I can bet on my life now that I am using the green tea ph alkalinity in slowing the growth of cancer in me,

Open your eyes again to this new reality,

Thanks for being patience,

Roland

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Hi Nal,

So green, or white, tea are of no use in fighting cancer, & we might as well use up the bladder space on water & coffee, right?'

Neal

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Not saying that: When I was involved in the discovery of what was and how many individual molecular compounds were in just the aroma of Tea---my research group came up with 480 individual compounds. Those proponents, that say Tea has major benefits, or even tout it as a part of a cure all because of the Polyphenolic compounds in the Teas, is where I take issue. The solubility of these compounds in 200 degree water is not all that much. The best parts are left behind in the tea bag. These compounds EC, EGC, EGCG, have enormous molecular weights up to 920---as any chemist will tell you the higher the molecular weight of something, the harder it is to get it to dissolve in water---our bodies are water systems---and if you let tea get cold, after seeping, you will notice at the bottom of the cup a small sludge forming. These are those big compounds. On top of that the stomach acid will break these compounds into smaller unknowns, all the way down to the base Gallic Acid Molecule--which is the building block to the Polyphenolic compounds.

But, the good news is if there are 480 compounds in just what you smell of the tea, how many are there in a cup of tea. There may be other components that are beneficial, that are cold water soluble, and are not harmed by the stomach acid. I just take issue with the touting of the Great Polyphenols in Tea as Cancer Cell destroyers.

I drink 16 cups of coffee in my day---no tea---the benefits of coffee against cancer---there have been a bin full of papers written in the past few years. I do not follow the chemical detective work anymore---as to coffee, as my past Caffeinated Beverage Research, just intuitively leads me to favor coffee. And lots off it.

But if tea floats your boat, then enjoy, as there are so many delightful varieties. I know what goes in the Tea Bags---and that would be a chemistry level, at a much higher level--regarding commercialization, for the taste benefit of the consumer.

Nalakrats

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Thank you, Nal! That's an excellent explanation. I've switched back to coffee,, too, although I'm not sure the amount my poor bladder accommodates is medicinal. But I'm happy to be back to my Peet's French Roast after years of first green & then white tea.

So my further questions are these, should you choose to address them: (1) Is there any point in washing down Life Extension's Green Tea Extract with my coffee or water, & if so, do you know anything about green tea conflicting with curcumin? As you know, Patrick is also a coffee lover. He used to take those supplements, but now believes they conflict with curcumin, & that the latter is the more valuable against PCa.

Thank you very much for your help, Nal.

Neal

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There are really no good studies--I continue to take my Supplements during the day and evenings with large volumes of coffee each day---as to Tea extract---I have no idea---as you have no Idea what is done to Tea, that can then get onto a capsule--It would scare you--like walking thru a meat packing plant for the first time. Tea can come from any part of the plant/bush. If they want to take the throw away twigs---and treat them with Lye, they become soluble, in water and they spray dry it after neutralizing out with acid---and you have Tea Extract in Capsules. or do you? These providers buy a powder and put them in capsules---the variances are so great who knows what reacts with what. And do they know what they are getting?

I know from my Tea Research at Lipton Tea in the 60's that there is magic we can do to the Tea Plant---but coffee is a different matter if you are buying top brands. It is pure and unadulterated. Cheap Store Brands, I would also be suspect to certain games that can be played. I know, as it was my business for the last 30 years of my Business career.

Nalakrats

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Thank you, Nal--interesting & scary.

Hopefully I haven't been harming myself because I quickly moved from green to white tea--in particular, Teatulia's white tea. Teatulia is an environmentally & socially conscious company out of Denver. Their tea farm, in Bangladesh, employs formerly unemployed local women. You can see the white tea buds & leaves inside the transparent bags, made from a soy derivative, & there's no dreck in there. It costs more than other white teas I found, but it tastes better & you can see clearly that you're getting what you paid for.

But I only switched from coffee because I thought green (& then white) tea offered more health benefits, & now that's flipped. Peet's coffee is delicious. They started nearby in Berkeley. Now I've got 1 a couple of blocks from home.

Neal

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Sounds like a great Tea source---You can do both---but I lean heavily towards the coffee---You can always have the Tea for a good tasting beverage. Hells bells, I like my Non-alcoholic Buckler Beer, after dinner. Take my supplements with it.

Nalakrats

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I drank a good imported or craft beer every evening pretty much until this year, This year, I'm trying to get more bladder control--it was shot to hell when a PCa tumor caused a spinal cord compression, which in turn was followed by spinal surgery, & later radiation. So I don't have beer very often. And I just drink 16 oz. of coffee in the morning.

Neal

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Good amount of coffee.

Nalakrats

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I'm glad to hear that--thanks, Nal. I read that 6 cups is optimal, but I just can't manage that.

Neal

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Very happy you, Neal, Patrick, and Nalakrats all agree with us about our favorite (or almost) beverage. We like red wine, too. Mrs. S

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Red wine is beneficial too, Mrs. S. Fortunately, coffee & red wine can be assigned to different times of day!

Neal

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Good morning, Nalakrats, and everybody who loves coffee as much as we do. Staying on topic, I’m sure I’ve read SOMEWHERE that it cures PCa. Seriously, we have just had a period of drinking green tea which took considerable will power. With your non-doctor’s but scientist’s permission, we’re going back to the good stuff. I can smell the coffee now.

When Leswell is done shoveling roofs, he may return to roasting Burundi from Roastmasters. Meanwhile we will use either the Technivorm Moccamaster with a Baratza Virtuoso grinder or Bodum French Press. Other than Burundi, we find KoffeeKult from Amazon doesn’t cause acid reflux and is beautifully, freshly roasted. It arrives in two days using Amazon Prime. We’re working on reducing our consumption of Grassfed beef or bison, Parmeggiano Reggiano (for my tomato sauces), etc. Just quit using half and half in favor of unsweetened rice milk. No comment. The movement, or lack thereof, is motivated by the inevitable, eventual PSA and the increasing threat of a blocked colon and more scans. Sad. I’d promise to behave if I could believe myself.

SKOL. Nevermind the Vikings, too. Alexa, whoever she is, predicts an Eagles Super Bowl win. Sounds strange to me. Either way, it’s never boring watching Brady throw or Giselle chatter away with Paul Hawkins about the environment. (That was back in the Charlie Rose days. More sadness.) Now if we could adopt the Bradys’ diet as happily—and borrow their chef. Go Patriots. Apologies for getting off topic. Jan, Mrs. S, JLS#2, whatever.

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Enjoy your coffee!

Nalakrats

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Does it have to be caffeinated or is it compounds other than the caffeine that may prove beneficial against PCa? I love coffee, but generally tend towards decaf as I find too much caffeine results in frequent trips to the bathroom and can keep me awake. Thanks.

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Much is taken out during decaffeination, but since they use sub-critical CO2 Extraction today instead of the nasty Chemical solvent extraction of old--at least the decaf---is a healthy version. But I know my CO2 extraction Chemistry. So my answer is always the same as I have been asked this question hundreds of times--in my life-------

GOD DID NOT MAKE COFFEE BEANS WITHOUT CAFFEINE.

Nalakrats

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Great answer. Thanks! Yes, the bean is a gift. I am hesitant to add too much caffeine since I don't want to exacerbate the side effects of ADT, but I will trend towards more caffeine since I miss it.

Stay well.

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When I was on ADT--I literally had 3 16 ounce mugs a day sometimes more. And now off ADT, I do not see any difference. I always drank that much. But that is just me.

Nalakrats

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I also switched to green, & then white, tea, & now back to my Peet's French Roast coffee. The recommendations just keep changing! First soy was good, & now it's bad. This site helps you keep up.

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Oops. Paul Hawken

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Please consider front line ADT, before you cause harm.

Nalakrats

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Hi Nalakrats

Thanks again.

I am catching up with an oncologist on 15 January 18.

I will also be ordering another CT & Bone Scan in 2 weeks time.

If my treatment doesn't show stable cancer / reduction by then I would have exhausted all my revenues.

So either I am right/wrong by the end of the month it will be revealed.

Roland

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I was diagnosed with Pca with bone mets three years ago. For more than two of those years I've been taking Metformin as prescribed by my MO. At the time he said that studies indicate Metformin "has some cancer fighting ability." It certainly is not a problem to take since I've experienced no side effects from it. Sounds like you're getting good advice.

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Are you, or anyone else on here, combining zoladex with metformin?

If so, have you had any concerning side effects from their interaction?

One the one hand there is plenty of postive research in US/Canada for including metformin - as usual the UK lags behind! - yet there are also documented negatives from its interaction with zoladex.

Like anything in this minefield, it's choosing the appropriate risk/reward decision. Looking for guidance / advice to help me make the right one.

I'm early 60s, diagnosed with stage 1c, Gleason 4 + 5 = 9 now metastasised.

I've been on Bicalutamide and Tamoxifen for 2 months and due to start zoladex next week.

I'm not diabetic, but have very strong family history of late-onset. I have recently moved to a diet almost free of sugar, dairy, gluten and processed food.

Should I also start metformin?

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Hi Andy1969 I was wondering if that’s your date of birth if it is we are the same age. I’ve been trying to get my oncologist in Cardiff to prescribe metaformin with no success. They don’t seem to have the same attitude to the drug in the UK. I’m on Zoladex also and I have now decided to ask my GP if he will prescribe it. 👍 sorry just read your in your 60,s which means it’s not your DOB.

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My oncologist wouldn't prescribe it. My GP did. I emailed him a study described by Patrick O'Shea on this site.

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Im UK based and having failed to get metformin and statins prescribed, I contacted London based Care Oncology Clinic.

Initial appointment then quarterly follow up calls provide me with meds in post. Cost total 250 GBP per quarter.

Happy with them.

Care Oncology Clinic Ltd

40 Harley St, Marylebone, London W1G 9PP

020 7580 3266

g.co/kgs/PNPfaE

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Hi Apollo.

Thank you for responding. I very much doubt your GP will prescribe it for an "off-license" use. He might agree if you are type 2 diabetic.

It's still being trialled in UK, despite numerous very positive trial results in US/Canada. You could ask your oncologist to see if you can join the STAMPEDE Trial, which is for adding metformin to zoladex (and chemo).

There are, however, some potentially serious interactions between zoladex and metformin .... it's all about choosing the right risk v risk scenario.

One could always try to order for diabetes use from an online pharmacy, eg HealthExpress.co.uk It's relatively cheap: 168 x 500mg is £30

Cardiff. I love the part of Wales between Cardiff and Swansea, in particular Kenfig & Sker Beach, Merthyr Mawr and the Ogmore - Dunraven stretch.

1969 was an especially exciting year for me as a youngster: moon landing and Concorde.

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