Scientists at The University of Texas Health Science Center at Houston (UTHealth) report that fat cells support the progression of prostate cancer and could be a key target in new treatments. Findings of their pre-clinical study appeared in the journal Oncogene.
tmc.edu/news/2019/01/prosta...
Drugs are under development accordingly
Does it hold that overweight men have more PC, more aggressive PC and shorter life spans after diagnosis than their less weighty brethren ?
Poorer survival of men with high BMI has been reported for years.
PubMed search on <prostate obese survival> returns over 400 hits.
I dislike the studies that show findings in terms of obesity. What if one's BMI is <30?
BMI is somewhat arbitrary. Overweight is 25 to <30; obese is 30 to <35; highly obese is 35 to <40 & morbidly obese is 45 & up. Ckearly, there is nothing magical about these cutoff.
The problem with fat - not dietary fat, but visceral fat - is that it acts like a gland in the endocrine system and secretes a number of hormones that affect PCa growth. Nothing new about that.
And, of course, visceral fat tends to increase with ADT.
One hormone that increases with fat is leptin. It's supposed to kill the appetite - the body doesn't want to be obese. Unfortunately, the receptors stop responding when leptin is always there.
One adipose hormone that is reduced is adiponectin. As leptin rises adiponectin falls.
In an early study at M.D. Anderson (2001) [1]:
"Men with high-volume disease exhibited higher leptin concentrations overall and after stratification by age, testosterone level, height, and body mass index (BMI). Analysis revealed that men with elevated leptin concentrations had an increased risk of diagnosis with high-volume disease (odds ratio (OR) = 2.35 ..."
In a 2005 study [2]:
"Plasma adiponectin levels were significantly lower in the PCa group than in the benign prostatic obstruction group or controls (P < 0.001 for both). Additionally, the plasma adiponectin levels were significantly lower in the advanced disease group than in the organ-confined PCa group ... Significant negative associations were found between plasma adiponectin levels and prostate-specific antigen levels or biopsy Gleason scores in the PCa group. The plasma adiponectin levels of those with high-grade PCa were also significantly lower than those for both the low-grade and intermediate-grade groups"
Visceral fat also secretes estradiol [E2]. That is unfortunate, since the mate body responds to excess estradiol by producing less testosterone [T], which further worsens the E2:T ratio.
-Patrick
[1] ncbi.nlm.nih.gov/pubmed/111...
[2] ncbi.nlm.nih.gov/pubmed/159...
Thank you Pjoshea. First, your many posts regarding the latest and greatest PC studies are greatly appreciated by the group along with your own explanations and thoughts on those studies. You a real priceless asset to this group. Thank you!! Obviously BMI plays a role and obesity or even being overweight has negative implications to the stage 4 PC men here. . In your opinion however, is there a point of diminishing returns and is body fat (and not just BMI) also a factor? I for example have worked hard while on lupron and Zytega:Prednisone) to lose weight and lift weights diligently with a trainer. I feel great and at age 62, I’m down from 200 to 190 pounds (at 6’1”) with a current body fat of 15% down from 18%. Would even lower be better on both counts or once you hit a certain mark you really aren’t going to do anything in regards to weight and body fat that will help increase your survival chances?
Thx
Schwah.
A major problem with the BMI studies is that BMI is used as a surrogate for visceral fat. Unfortunate, it would take a scan to assess internal fat, whereas height & weight are easily available.
There are certain body types where a high BMI does not mean there is increased health risk.
& then there are the TOFI men:
-Patrick
I've never been overweight based on BMI number, but have suspected a degree of "skinny fat" for years, which would explain my cholesterol numbers. After diagnosis I lost 10 lbs mostly due to side effects of radiation. My PSA has since plummeted to less than 1. It's an interesting anecdotal data point if nothing else.
Pat
Would liposuction to stomach fat from ADT reduce PCa risk?
Visceral fat is fat distributed around internal organs. High glycerides (as in a high=carb/low-fat diet) tend to be stored that way. However, ADT fat seems to be preferentially stored subcutaneously. One study [1] found no increase in visceral fat, while another [2] reported that "The increase in subcutaneous fat was significantly greater than that in visceral fat ..."
In one study of biochemical failure in obese men [3]:
"Calculated percent visceral fat thickness was ... significantly larger in obese men with biochemical failure" whereas:
"The anterior fat thickness on eMRI in obese men with biochemical failure ... was significantly smaller than obese men without biochemical failure".
Looking at cancer in general, there are many papers that support the idea that visceral fat is a mortality risk factor, e.g.:
"Higher visceral fat area/subcutaneous fat area ratio measured by computed tomography is associated with recurrence and poor survival in patients with mid and low rectal cancers." [4]
The fat that we cannot see may pose a significant risk to survival, & only a scan will tell us if it is an issue. ADT itself will increase visible fat at a much faster rate than visceral fat, so visible fat cannot be used to infer the existence of a visceral fat problem.
Liposuction wouldn't address visceral fat & I can't say how useful it would be.
-Patrick
[1] ncbi.nlm.nih.gov/pubmed/292...
[2] ncbi.nlm.nih.gov/pubmed/265...
[3] ncbi.nlm.nih.gov/pubmed/213...
[4] ncbi.nlm.nih.gov/pubmed/297...
Thanks. I wasn’t looking forward to liposuction anyway. My lipids are all good due to being on Crestor (rosuvastatin) and managing my diet but I hate the belly fat . I’ve been taking Keto pills for over a month with no resultant weight loss but my gut seems to have shrunk a bit. And appetite seems to have wained .
Patrick
Fat is not just what you carry on your body. More importantly is the fat in our blood , known as Triglycerides . Triglycerides is the key factor of the aggressive PC , not your BMI .
There are also articles on NHI , on relation between Triglycerides and aggressive PC.
It’s possible , a person may not be overweight but have high Triglycerides, as I do.
Bob
Are you a member of the facebook group Jane McLelland Off Label Drugs for Cancer? You would find it very interesting as she discusses the role of fat and glutamine with prostate cancer. Glucose is only recruited later in advanced prostate disease. She has a book too on the subject of starving cancer.
Have you found that one can build muscle while on ADT? Can you prevent the flab?
Thanks, I’m just starting a minimum of 1 year on Lupron and Zytiga
Yes yes yes. I am 62. I was so worried about all I had heard. My MO said the key is resistance training (basically weight training). I’ve told this story before here but glad to repeat. I found a local highly recommended weight trainer. I though I was in decent shape. 6’1” and 200 pounds. I went to the gym a few times a week, chatted with boys, lifted a few weights and did a little easy time on the tread mill and went home. When I went to this trainer I told him I was going to have zero testosterone and I took off my shirt and asked if he could make me look no worse in a year. He said if I looked like that after a year at his gym he was closing the doors. Lol. He works me like a dog. I swear each time will be my last. I do a little over an hour 3 times a week and I’ve missed only one session I8 months. I get plenty of cardio in that hour plus because he pushes me from one thing to the next very quick. All muscle groups. I’ve lost 8 pounds and reduced my body fat from 17.5 to under 15%. I have more muscle tone than 20 years ago. Best of all I feel great despite 18 months of Zytega , prednisone and lupron. If not for a reduced libido and occasional stomach issues I’d never know I’m on anything. Less fat and exercise is also proven to help fight PC. If you can’t afford a trainer all the time, go once every three months and have him set you up on a Program. I do no other cardio (although I should) but I do play golf a Couple of times a week. In a cart. Lol. You can beat the affects and feel good. But you have to pay the piper. Good luck my friend. Feel free to personal message me and I’ll sevd before and after pictures to prove my point.
Schwah
Wow that’s awesome to hear! Congratulations! I appreciate the feedback! I’ve been resistance training for 30 mins most everyday but it’s mostly rowing, jumping, light arm weights and steps. I’ll get with a trainer to set me up on a weight lifting program. I’m going to have radiation two months from now and will try to exercise during the 6.5 weeks.
Thank you again!
Fat is not just what you carry on your body. More importantly is the fat in our blood , known as Triglycerides . Triglycerides is the key factor of the aggressive PC , not your BMI .
It’s possible , you may not be overweight but have high Triglycerides, as I do.
30 years ago, I was eating whole grains, lots of vegetables, some fish & (not intentially) very little fat. I lost weight (which wasn't actually my aim) & all my lipids looked good except triglycerides. Do doctors even look at the number?
About that time, Barry Sears Zone book came out. I don't know why I was interested. I hadn't bought a diet book before & haven't since. What I remember most is that he said triglycerides should be <100 & no more than twice HDL-cholesterol. He might not have mentioned that the triglycerides:HDL-C ratio is a surrogate measure of insulin resistance.
I made an attempt to balance each meal in the carb:protein:fat ratio that Sears advocated. Nothing much changed except that triglycerides dropped ~100 points & became ~equal to HDL-C.
In one of his vlog posts, Dr Myers praises Sears.
The importance of the triglycerides:HDL-C ratio became clear to me when I discovered that diabetics get more cancer of every type - except PCa. We know that PCa cells mostly do not use glucose & diabetics don't necessarily have glucose control, but they produce less insulin - a known cancer growth factor - because of beta cell die-off. I figured that pre-diabetes is a PCa risk factor.
The pre-diabetic tends to favor diets that produce glucose spikes. That leads to insulin spikes & insulin resistance, but also to triglyceride spikes (from excess glucose). Excess triglycerides are stored in fat cells - preferentially as visceral fat. One need not be over-weight to be fat inside.
Dean Ornish promotes a low-fat (10%) vegan diet. Critics point to high triglyceride levels in those who eat that way. In his famous PCa intervention trial, men started out with high triglycerides - the average was close to 150. After a year, all lipids had improved (although HDL-C may have gone down a bit), but triglycerides had gone up!
Dr. Myers has said that his patients on low-fat diets tended not to do well. & of course, he advocates the 40% fat Mediterranean diet.
-Patrick
Thanks, Bboby - this type of information is exactly why I've joined this site. I may be an iron man when it comes to understanding and tolerating treatments, but I have largely been an uncommitted, self-pitying boob when it comes to diet and food....an area completely under my control. Pjosh's observation that we are essentially keeping a gland around that helps PC is chilling. - Joe M.
It would seem that a retrospective study, such as BMI vs PSA in a cohort of men, would answer the eternal question: do lab result translate to real world?
GOOD... That means my ex-wife is in deep doo doo... oops... i forgot she's a female...
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 01/12/2019 12:12 PM EST
I'm 5' 10", 150 pounds and my weight hasn't changed since high school. Quite low body fat level - around 15% when last measured. And I still have very aggressive cancer. No "magic bullet" I'm afraid. Every one of us is different.
5' 9" about 145 lbs. my whole life. So skinny, people thought I might have cancer. Now I do have cancer and weigh 162 lbs. and look like I'm pregnant. I try to avoid all mirrors.
Isn't it odd that luperon and other hormone cancer drugs put weight on the patient with no recourse, but to get fat around the middle! I know, I've gained at least 30 pounds even with strenuous workouts daily.
Great.
Just glad in a sad way lots of us in same boat...im 6'4 and was 264 lbs when dignsd
...i work construction so considered my self horse strong...never had 6packs but was a big strong guy...even at 60...now 18mos of lupron...im 287 and have nice c cups...the tire around the middle is sickning...and all the walking, toe touches.etc hasnt budged it....now psa is rising and really thinking of no further poisons...like the guy said the lack of libido...is the double whammy...but we are alive to an extent.....oh and by the way got to do bucket list golf trips to pebble and hilton head....amd because of lack of t...and resulting musce loss...tore ligaments in forearm.....ortho says to lay off the golf indefinitly.....talk about loss of quality of life.....
Ya bobby!, and as NPfisherman says, be lean and mean.
If only that was easy for most ppl after turning 40, with the Food Industry working overtime to make sure we all too eat and drink far too much, with most of it being semi toxic at least.
But I wonder how much difference being slim makes, because there would always be some fat cells sloshing around out arteries and veins, even if we were on a starvation diet...… I have tried so hard to keep BMI below 25, waist < 95cm since 2006, and cycle 140,000km. Was it all for nothing? Nah, I enjoyed it all, even without exercising my PG with specific PG exercises which I dare not say too much about lest I offend readers with genteel good manners of never discussing sex, politics or religion.
Patrick Turner.
Patrick, I like it when you discuss all that stuff you mentioned. Guess I am not genteel.
My husband has always been skinny and lately lost 10 pounds being on Xtandi and castrated. Perhaps that is why he has had pCa for 18 years and still lives to complain about too much doctoring. He drinks beer and watches lots of football but has started lifting weights while watching.
Hi mjbach, and to all other wonderful ppl here.....
There is a trial going on at Prince Alexandra Hospital in Brisbane Australia where men who get too slim while having ADT etc for Pca are given a daily 40mg oral dose of testosterone which goes initially to liver to be broken down but none of it ends up in the bloodstream like injected T where it would then go to Pca sites to boost its growth.
The slimming problem is called Sarcopenia, and its a frightening condition where one loses say 5% of weight a year.
As the 40mg oral dose of T is broken down, a muscle growth chemical is made and this activates muscles to grow, not whither away.
I read about this idea, and about available T online which is in very high demand by men in a big age range who are disgusted by their whimp figures, and desire to look more sexy, and not have sand kicked in their face while at the beach, where everyone gets to see each other nearly naked.
Most T is in a bottle for injection, and it is dangerous to inject T because it could make T level in blood higher than the natural level and thus make it more likely a young man would get Pca later in life, plus there are other side effects, mostly bad.
The older man with Pca should not inject, but the trial hopes to show that muscle wasting can be much reduced with oral T and thus the older man can cope better to do more exercise, thus he generates a bunch of other feel good chemicals and he copes mentally better.
The trial is testing blood T levels and Psa of men in the trial to be able to find how many thinning men get a benefit.
In my case, I have very low T, and I'm on the way down, I'm losing height because vertebra are losing cartilage and coming close together. But unlike so many men over 60, I have cycled an average 220km a week since 2006, and changed diet to mainly vegetarian and I have no bad habits like booze, over eating, smoking et all, and during Zytiga + ADT weight dropped 2Kg but speed on bike went high as years ago, so muscles were fine.
weight has been +/- 2Kg from base line of 83Kg since 2006, and I was 83Kg when I was 40 and raced and trained on bikes and worked as a builder on the tools. I could not be sedentary unless I was sick.
we are getting the second big heat wave this summer, 35C today, then 39C, 40C, 40C over next 3 days, so weight may drop a Kg due to some loss of water. I don't have air con.
Presently, I am on Lu177, and a hip is still tender, because I know its one of 4 bone met sites where mets are big enough to attract a lot of Lu177, and then make the whole area sore from inflammation. So Lu177 + Pca has stopped me cycling now but I hope the Pca slows and inflammation goes down and maybe I ride well again. But there are many Pca men who are prevented from exercise because of pain, and for me, to not exercise would put me on the steeper slope downwards for QOL and increasing rate of disintegration we all have to face with age.
But the pool water is very nice, and I'm off to lunch at a happy café, life is good, and there is no point complaining.
I have a friend who is 60, and has worked all his life in building trades, and he has the solid strong look, and the work has kept him strong. His PG is most likely to never give him trouble because like a cousin of mine its < 1.0 with plenty testosterone. But really, he could sure lose 15kg, and if he did that and stay strong, wow, what a man. But like so many of us, his control over food intake is weak, and getting overweight is a mostly mental problem; I should know, because in July 2006 I was 102Kg, but by Dec I was 83Kg, all because I changed diet more severely, stuck to the darn thing, and began to pedal the fat off in a bicycle by spending 10Hrs+ a week going so hard I could not talk to anyone, not even to myself.
But I could always yell at a motorist after he's just tried to run over me on the bike, oh yeah, and keep a finger up at him, un-make his day, all without testosterone. 
!
Building work is a series of mostly lifting heavy things without raising the heart rate much. It is nor aerobic exercise where you get to go for hours with a raised HR. This is what burns the calories, and you have to resist the urge to eat, and most fail this idea, because they'll eat high sugar+fat food. For a snack at 9pm, I will just have more of the salad I had at dinner at 5:30pm, and have a red pepper or some tomatoes. So by all means eat to kill the hunger, but eat nothing with calories.
Back in 1970s, Nathan Pritikin pointed out the lifestyle needed to exclude and obstruct the input of shite into the body, and how to get the best from your body, and he achieved marvellous things with his body, and his mind,
Tragically, he died of leukemia at 72. People look at this fact and a voice in head says " well all that health stuff was BS, " so they have 3 slices of chocolate cake to make them less anxious after reading about the life of Nathan, but I know they'd be far better off eating 3 tomatoes to get rid of anxiety. There are plenty of things to eat which have vitamins but no calories, and QOL is about NOW, and sure you'll die one day, but what about NOW?
Patrick Turner.
It also suggests that healthier dietary habits, like NO Junk food, soda or added sugar may help. A focus on fresh (organic whenever possible) Fruits and Vegetables may benefit.
When I went on Firmagon my weight stayed steady at about 69kg for 1,68 metres.
My blood sugar rose from 1,33 to 1,76 and I started on metformin.
I am on metformin 2 times 500 mg per day and my blood sugar is back down to 1,33 and I have fallen to 66,6 kg.
I have lost a lot of subcutaneous body fat, I was on metformin 2 times 850 per day and I felt tired but the weight fell off, I was down to 65kg when I changed to only one 850 mg tablet per day.
I have an understanding GP who does not mind if I do intelligent adjustments to my drug regime.
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