Statin and COX2 inhibitor for MCRPC?

[Rubyrose1234]

Hi all, this is my very first post on this site and I must say many of you are very knowledgeable with regard to PC and its treatment. My husband was diagnosed at 57 with PC, PSA 60, T2b following prostatectomy and Glesson 4+3. PSA returned after surgery very promptly and the next two years followed with stereotactic radiosurgery to two lesions and ADT, and then last year a PSMA scan revealed multiple very small mets of the axial skeleton, and castrate resistance . We then embarked on Docetaxel 10 cycles and 12months after starting chemo his PSA is rising again currently 7.5 at present. We are about to have another PSMA to look for any bone target that might be worth some radiotherapy, just incase it is one or two sites that have progressed. Allan is very fit and runs 7km most days. Phew, so my question to all is 'would there be benefit in adding Celebrex to the Atrovastatin Allan is already in the setting of MCRPC'. I have read the literature on metastatic hormone sensitive PC and Celebrex. Was just hoping you might know, and any other adjunctive therapy that has some research behind it. BTW we are from little old New Zealand and I forgot to mention we have an Accident Compensation Claim for delayed diagnosis which acts a bit like insurance, so it the drug or treatment is available in NZ we will be able to access it.

[tallguy2]

After chemo, your husband may be a candidate for second-line therapy such as abiraterone. This is what I am doing.

Best wishes. We spend 3 lovely weeks, both N and S island 3 years ago and very much wish to return!

[Tall_Allen]

Celebrex + Zometa has been shown to increase survival. Celebrex alone does nothing for survival, although it may reduce pain.

Statins probably have no effect of prostate cancer based on the best data we have (below), but statins may be useful for CV disease.

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

Can you get Xofigo? Provenge?

[Currumpaw in reply to Tall_Allen]

Hey T_A!

Your link doesn't load. I'd like to give it a scan. You always have something interesting.

Currumpaw

[Tall_Allen in reply to Currumpaw]

It loads for me. Try again.

[tango65]

Statins may have a positive effect in overall mortality and in specific prostate cancer mortality. The effect could better if metformin is used with the statins.

onlinelibrary.wiley.com/doi...

Celebrex seems to be effective when combined with zoledronic acid.

[Claud68]

He could get a Ga68 psma petscan and try the Lu177 treatment if he has psma avid mets.

[MateoBeach]

Tall_Allen is correct in that celecoxib has been shown to be of benefit when combined with Zometa. However I am not aware of any prospective randomized trials of combining it with a statin. There is preclinical (laboratory) evidence of activity against prostate cancer and retrospective data in comparing medical records of prostate cancer patients. So this lower level data, while not definitive, suggests to me that it may be a good idea to continue both the atorvastatin and the celecoxib and also ask his MO for Zometa. Full disclosure: My personal bias as a patient is to "leave nothing on the table" that may reasonably be of benefit and is not harmful, until proven otherwise.

ncbi.nlm.nih.gov/pubmed/320...

[MateoBeach in reply to MateoBeach]

Bowing to recent feedback from T_A, who keeps me clear about levels and reliability of evidence: while I am impressed with this study, it is certainly susceptible to ascertainment bias in that those taking statins or Metformin or both probably have more regular contact with physicians and thus may be given more optimal care that could impact their prostate cancer outcomes in other ways.

[immunity1]

Howdy. Is that lake full of trout? Zoledronate and celecoxib are both available and Pharmac-funded in NZ. I have mCRPC, take both and have just finished 6/10 cycles of docetaxel . Rob

[AlanLawrenson]

Hi from an overcast Sydney. I seem to recall that Lu177 is now available in NZ. I am not not necessarily suggesting it over the suggestions already made, but it might become a another tool in the arsenal, although an expensive one.

[j-o-h-n]

Greeting Rubyrose and Allan.... keep posting here for good info, best wishes to you all down under, down under....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/07/2020 1:09 PM EST