Benefit of statin and metformin in the treatment of high risk CRPC

[dress2544]

Hi everyone

I have seen that many posts in this forum indicate that the addition of statin and metformin in the treatment of prostate cancer will be beneficial during hormone therapy. In my case I am on second line hormone therapy (Aberaterone + Prednisone ) for the past one year. I have undergone orchiectomy also recently. My present psa level is 0.83. I hope that I can prolong the use of Aberaterone in the disease control for more period if I add statin and metformin to the treatment. Am I right in my understanding? I hope to get a wise opinion from my fellow- members in this regard. I also wish to know which type of statin will be more beneficial to add.

Thank you all.

[Tall_Allen]

Maybe. Lots of conflicting evidence - none of it of good quality - but why not try it? If statins help, it would be a hydrophobic statin like simvastatin (Zocor), atorvostatin (Lipitor). and lovastatin (Mevacor).

[mklc in reply to Tall_Allen]

Can you suggest the dosage of statin to take?

and also the metformin?

Many thanks

[Tall_Allen in reply to mklc]

I would start at low doses of each. You never know who might have an atypical reaction.

[mklc in reply to Tall_Allen]

Thank you so much.

[CalBear74 in reply to mklc]

I have been taking the natural equivalent red yeast rice to Lovastatin for the past 20 years for CHOL management. I have used the UCLA guideline from the early nineties which called for two 600 mg. capsules in the AM and two in the PM. I have long used Solaray because of the consistent quality of their red yeast. I once used a cheaper brand and my CHOL immediately rose. My LDL has never exceeded 100, which was the maximum the medical director of our company would permit due to the data. It clearly indicates that cardiac issues begin when LDL goes over 100. Our medical director spent many years as an ER doc and FP. He said he never had a heart attack patient with LDL under 100. He said the huge Framingham Heart Study supported his experience (late nineties). I never had any side effects from red yeast but some people do apparently.

I can't help on Metformin because I take the natural equivalent Berberine root and it isn't comparable for dosing. Berberine has very effectively reduced my A1c. Again I use Solaray. My PCP is happy with the results I get from both.

[cesanon in reply to CalBear74]

"He said he never had a heart attack patient with LDL under 100. " While perhaps this basically may be sort of true, that sounds like pompous exaggeration to make a point.

Personally, in business and in health matters, I tend to automatically run away from people that engage in pompous exaggeration to make a point. In my experience, relying on their decision making is almost invariably associated with disaster. Oh and also pompous politicians that a loose with the facts as well. LOL

So UCLA recommends red yeast rice of uncertain and variable potency as a substitute for Lovastatin with pharmaceutically measured and predictable potency? Do you have a citation or link for that?

I sort of find that hard to believe. How do you go about calibrating dosage of the active ingredient?

[CalBear74 in reply to cesanon]

Your need to understand this physician provided this information to me in a conversation as we worked together on medical software for a number of years. He was encouraging me to get serious about reducing my LDL, which I did with red yeast rice. I did not say UCLA was advocating red yeast as a substitute for lovastatin. I find the overall tone of your response to be offensive. I will end this interaction at this point and be sure to avoid you in the future.

[cesanon in reply to CalBear74]

Sure. I tend to do that to the "nuts and berries" crowd.

Now I take supplements myself and I try to eat well. And appreciate the benefits of getting proper nutrition from a balanced diet of real food, preferably organic.

But when one can choose between (a) reliably calibrated doses and (b) gathered herbal substitutes (of uncertain and varying purity and potency)... both with the same active ingredient, I think someone needs to point out to others who come here for information, that this can be needlessly risky behavior that you should think twice about before engaging in.

Certainly, you don't believe that you will never have a heart attack if all you do is keep your "LDL under 100".

It is a complex world out there. There is no shortage of irrational patient self-medication and self-treatment (such as Steve Jobs treating his treatable cancer with Aryuvedic medicine until it was too late to save him).

There are points and counterpoints. They are best seen in sunlight so that people may choose.

And you wouldn't want someone to unintentionally take what you quoted your medical director as having said... literally.

[dress2544 in reply to Tall_Allen]

Thank you Tall Allen for your prompt reply.

[podsart in reply to Tall_Allen]

The hydrophobic statins seem better Re PCa ala recent discussion simistatin and Xtandi. From what I read , the hydro statins ie Crestor don’t have as many bad side effects, as fats based can cross into body areas that hydros don’t

Dr Myers seemed very concerned re small particle LDL and felt Crestor was better. Thought he said Crestor better for Pca , didn’t say why

I would appreciate your view on these items

[cesanon in reply to podsart]

"Dr Myers seemed very concerned re small particle LDL and felt Crestor was better. Thought he said Crestor better for Pca , didn’t say why"

Yeah basically that is what I took away from him too.

Patrick and Tall Allen seem to do their research. And the problem for all is that the data, for our purposes is incomplete.

I am thinking that long-term maybe I should use Crestor... but if the PSA is starting to look like its rising... then simvistatin. That is sort of where I am, tenuously, on this issue.

[TheTopBanana in reply to Tall_Allen]

Could one add statin and metmorfin at any stage of treatment?

[Tall_Allen in reply to TheTopBanana]

Since this old post, more and better data have come in. There are good reasons to take both of them (cardiovascular health and diabetes), but prostate cancer is not one of them, as far as we know.

• They suggest that the supposed benefit of statins in PCa may be due to a depressing effect on PSA tests rather than a real effect on cancer.

bjui-journals.onlinelibrary...

nejm.org/doi/full/10.1056/N...

• They suggest that the supposed benefit of metformin may have been an artifact because diabetic patients were less likely to be screened for PCa. In RCTs, it was found to confer no benefit in several situations:

jamanetwork.com/journals/ja...

ascopubs.org/doi/10.1200/JC...

meetinglibrary.asco.org/rec...

urotoday.com/conference-hig...

[Spaceman210]

I take metformin based on MO recommendation, along with a beta blocker carvedilol. I am also on a low dose of pravastatin for cholesterol and had problems taking stronger ones. Metformin has some slight GI effects to be aware of - take with food. Too soon to tell in my case if helpful and am not on ADT at this time.

[cesanon]

Metformin is sort of a no brainer, but some people have digestion problems with it.

I think most docs, if they are willing to prescribe it, will prescribe up to 4g per day, but they will start you off with 1G per day.

[David2703]

Metformin 2500 mg a day

[GeorgesCalvez]

I have slightly raised blood glucose so I have been on 2 x 500mg of metformin a day for about nine months now. I tried 2 x 850mg a day at the start and it was just too much, I felt listless and I had digestive problems as well.

I have also been taking avorstatin, I got that for slightly raised cholesterol, and irbesartan for my blood pressure which rose quite alarmingly when I started Firmagon.