The highest level evidence so far is consistent. In 2024 we will get a more definitive answer from the STAMPEDE-K trial.
prostatecancer.news/2019/11...
(edit: Because "levels of evidence" seems to be a difficult concept for many laymen, I added a section on the conflicting observational evidence, and on the possible dangers attached to metformin use)
Interesting. I started taking metformin a few years before I was diagnosed with PCa. So, I will continue. But I was hoping for some kind of anti-PCa effect from the metformin. This trial looks rather small with a fairly short time-frame. As luck would have it, I have aggressive, N1 prostate cancer. So perhaps it might benefit me.
Perhaps a better answer from the STAMPEDE trial. Is it a larger trial for a longer duration?
I certainly plan to continue. Why These SOC honchos are so emphatic to spread this type of study........You need to think.. why so much effort to derogate Care Oncology Protocol...Threat to Billion dollar profits ?
It is important to know what is being said...But it is far more important to know who is saying it and why ? Salesmen in full bloom !
Some of us still trust the scientific process. What else is there - your hunches and internet fake studies?
Calm down..I ..Do Not worry about me..I have believed in scientic process since age 4 yrs.
It's important to translate beliefs into actions.
Tall.. I just had Video session with my Oncologist who has 42 years experience of treating prostate cancer. She was reluctant about me using only Bicalutamide and Finasteride last year. I went against her advice after studying dozens of older research studies and went ahead with my treatment choices. I check many biomarkers every 2 weeks and do scans every 2 to 3 months. Today, I saw her after 12 months. I presented to her all data from last 12 months. She looked carefully everything and said " I think you should keep doing what you are doing.. because it is working....Proof is in the pudding."
I am feeling like what I used to feel 5 years ago and able to run 5 miles non stop every day. For me this method is nothing less than scientific process. I do appreciate your concern for me but I am very prudent. Today's PSA 0.3 and BALP 10.2.
How can you possibly know what is going on on the molecular level? And you have no idea what the results of a better therapy might have been. The only sure way we know to delay castration resistance is ADT + a second-line hormonal therapy. Everyone feels good with less medicine, until they don't. That is not science. You are just fooling yourself.
Personally, I think big pharma has a lot to gain if they can show a survival increase with cheap, existing drugs. Nobody is saying metformin will cure prostate cancer on it's own, but if it extends time to progression or overall survival when paired with a blockbuster drug, they win. You can't sell Xtandi, etc. to dead people.
It didn't add anything to docetaxel, Lupron or Casodex, but perhaps it will when paired with Xtandi in the "IMPROVE" RCT.
I should have also mentioned the use of prednisone with abiraterone and some chemotherapies. Or loratadine to manage side effects of Nuelasta, because there's no precedent for the use of relatively cheap and available drugs where they have proven benefits. 
I would prefer to be on Sertraline (Zoloft) due to this research:
Repurposing antidepressant sertraline as a pharmacological drug to target prostate cancer stem cells: dual activation of apoptosis and autophagy signaling by deregulating redox balance
on this site:
ncbi.nlm.nih.gov/pmc/articl...
In fact my GP put me on it due to a severed depression caused by my 2 cancers and my other health problems. Being on it since 47 days and it just start to work. It often takes up to more than 6 weeks to work.
Depressed-- need to learn not to focus on cancer and focus on life whenever possible. Life is good. Best of luck and keep us posted.
I am learning but with ALL my health probleems.
1994 = Discal Hernia that was operated and then became in
2004 = Chronic Acute Lumbagy on Fentanyl 87 mcg/hr patches.
2001 = Chronic Renal Insuffissency Grade 3.
2019 = Lymphoma LNH Marginal Zone.
2020-03 = PCa Grade 3 became 4 after VMAT=RT on Planing CT-Scan.
2020-10 = Severed Emphysema Gold Grade 3.
2020-11 = Severed Depression on Sertraline (Zoloft) 100 mg and multiple R/Vs with a specialized psychologist for peoples with multiple cancers and heath problems.
The brain can not cope with all these problems and need HELP.
Wow.. you weren't kidding about other problems. Makes my problems look small in comparison. Been looking into Sertralin( Zoloft) myself acct newly released study showing it has antiproliferation properties with Pca. Seems it can help with more than depression. .
Yes it is GOOD news. When my GP prescribed the Sertraline and I gave her the link to that article, she was surprised and happy for me.I found this article from AJCR about 2 months ago and I was happy to use 1 drug to fight 2 diseases. 2 for the price of 1.
Amazing what we find that Drs don't know. We seem to have more motivation than they do.
Just got a call from my Haemato-Oncologist that orders me a very special blood test on Jan 5th 2021 at 09:00 and a R/V at 11:00 the same day.
Does not look good, my Lymphoma woke up, the bastard.
So it look that 2021 will look like 2020 and 2019.
Well I am not getting my break but I WILL FIGHT.
I just check your history and it is not so good. I did not get burned. Out of 12 biopsies, 6 of the right side were G(4+3=7)Grade 3 75% to 100% of the cores and when they did my Planning CT-Scan they found multiple tumors on all the prostate closed to the capsule and the Seminal Vesicules.
My prostate at that time was 45.8 cc and they VMAT-RT 139.6 cc (whole pelvic area).
Thanks God,the abdomino-pelvic CT-Scan was negatif as the Bones Scan was too.
Was put on ADT, Lupron Depot 22.5mg/12 weeks X 2. My PSA went from 13.6 to 22.4 and to 0.03 so my RO held my ADT due to my great response.
Had a series of blood tests on 2020/12/15.
My lymproma seems to start acting so my haemato-oncologist prescrived a CT-Scan+ Thoraco-abdomino-pelvic on 2020/12/29.
My kidney problems are still there but stable à CRI stade 3. So far, no treatment but drink a BIG LOT of water to flush out the creatinine.
Resume: 2020 was a very shitty year for me as 2019.
Hope 2021 will be better but I am already booked for another cystoscopy, another Pulmonary Functions Test (PFT). R/V with my RO and HO in March 2021.
I have biweekly R/V with my psychologist and ON Zoloft 100 mg for at least another 6 months.
With my lumbalgy I am physically limited but I force my self to have 2 walks a day.
My hot flushes were really getting me down and I decided to try some sertraline to help with them and maybe interfere with my PCa. Don’t know about the PCa but i haven’t had a hot flush meltdown since I started the sertraline
You mean it can help with hot flashes ?? Mine bother me since I had to quit the Megace which interfered with my driving....
I don’t know if sertraline affects the frequency or intensity of hot flushes, but it seems to help with my attitude and response to them.
Yeah Doc but other than those things.......how was the play?
If you mean pleasure, my daughter call me everyday but my 4 boys are either to busy or mad at me because I cannot give them money. Even with Quebec Medicare, I spend a lot of money on my medication and my retirement funds have been chopped by 2 divorces. The last one was terrible and my ex-wife had make me look awfull to my last 3 sons.
But I read a lot of sci-fic. That is a pleasure for me. No TV watching or movie.
And with the Covid-19, my only ''sorties'' are to go to the hospital.
I live in a sqare and morning and afternoon with my walker I walk about 0.75 km each so everyday I walk a minimum of 1.5 km and when I go to the hospital then it makes it 2.1 km like this past Tuesday. I have an app on my iPhone called ''Stepsapp'' that gave me my results. I setup my goal as 2,000 steps daily.
Sorry. It's an old (and bad) American joke. President Abe Lincoln was shot at a play. So the bad joke is asking Mrs. Lincoln, other than the shooting how was the play? You've been through so much, almost as bad as being shot at the play. So I was making a poor analogy. Glad you have your daughter in your life. I just walked mine down the aisle in September.
Well at least, I am still alive and ticking like that rabbit battery commercial.I have 2 grand-children.
I have 4. If I had known how awesome grandchildren were I would have just skipped kids and gone straight to them.
At 14:30 I will go for my second walk.Even with my relation with my 3 younger sons I would still do the same.
I was present to the 5 deliveries and I did have a good time wjth them.
But it is awfull when somebody uses the children in a divorce. The problem is between 2 adults so leave the children alone.
Like vitamin D is this another alternative cancer therapy that have been "disproven"?
Yes- I would love there to be simple solutions for things as biochemically complex as prostate cancer.
There is always a ready market for simple solutions to complex problems.LOL
Guess so....been on 2k mg day for 15 yrs still got highgrade apc.....
"Some people respond and some do not" Agree. But badmouthing perfectly good, old ,inexpensive meds and exaggerating benefits and hiding serious side effects of new and shamelessly expensive medicines..is what bothers me.I am on Bicalutamide 50 mg a day and it is working perfectly well with almost no side effects. It does not cause high blood pressure and diabetes in many people as Zytiga does. There is no seizure risk as Xtandi has. My PSA is 0.3 will 100% intact prostate only with Bicalutamide. In my opinion, Bicalutamide should be the most preffered med. What an evil conspiracy to keep this fine drug on the sidelines and calling it weak and ineffective drug. People have stayed stable on bicalutamide for 5 ,6 and even 10 years. Ask Magnus.
Scaring scared people is an age old sales tactics.
Ignoring medical science is dangerous. I wish you well, but hope you will come to your senses.
I am not diabetic so I couldn’t get any physician to prescribe it for me, so I tried Berberine for 3 months and as every other supplement , it failed to slow the psa rise. Just my own experience.
XPO1, I am not interested to engage with you in "pro Pharma" "anti pharma" stuff.I agreed with your statement" some people respond some people do not."
Your argument about research funding I have been hearing from sales reps of drug companies for last 30 years. Reality is marketing expense is bigger than what they put in research. . Oncos have been made slaves of the industrial complex.. They have lost their independent logical thinking and have sold their souls to the complex. One simple example is "did your Onco ever tell you that you should stop or minimize eating Animal Fats and Animal proteins as these foods promote growth of prostate cancer."
Did he/she ever tell you that heavy, long term ADT causes Neuro Endocrine variants which are deadly forms of PCa in 30% of patients. ? Did he ever tell you that you should reduce your systemic inflammation to lowest level to slow down cancer progression. I have empathy for your doctor.. the poor guy is paid $50 per visit and have to finish everything in less than 15 minutes. And the legal sword hangs on his neck all the time. I cant blame him.. I know better. American doctors have been enslaved effectively by SOC mafia and their accomplish F*FDA.
My experience has been totally different. Plus it includes Snuffy's successful multi-pathway treatment approach (which I will not go into here). There are likely thousands of others out there who are not moved by this "study."
It's not a "study," it's 7 prospective trials, all giving the same message. There will always be patients who prefer their quasi-religious attachments to actual science.
What is a prospective trial?
A prospective trial is when they give a bunch of guys with certain characteristics (like metastatic, castration-resistant, etc.) a certain therapy and watch what happens to them. A randomized clinical trial (RCT) is a prospective trial where (usually) half the guys get the treatment and half get a placebo or some other treatment. It is the only way to prove that a therapy works. In contrast, a retrospective study is just looking backwards in time and seeing how people fared.
As discussed in the article, the big problem with retrospective studies is "selection bias." The people who got a certain therapy got it for some particular reason, rather than because they were randomly given it. Retrospective studies are only supposed to be used to generate hypotheses to be tested in a prospective trial. They only show association, not cause. Unfortunately, because they often lead to such wild predictions, the media and some people on this forum draw inappropriate conclusions.
So, this prospective trial is close to be worthless. thanks for your time
Why do you think it's worthless, because you feel differently? Thank God, science doesn't depend on your feelings. Thanks for your time.
TA, first, you have good info and obviously know a lot about APC. But, second, your message frequently seems to be destroyed by the way it is delivered.
On the metformin, vitamin D, statins, exercise, etc issue, I believe that each of us is different and will respond differently. This is why I don't put a huge amount of stock in a study that only has a small number of individuals and only follows them for a short amount of time. And if something is supposed to be 75% effective but looking into the study shows that the 75% were people completely unlike myself and the 25% who did not respond had similarities to me, how do I view it?
How many people like "me" were included in the first study? I'm APC with N1. So, from the tiny first study, it looks like I should take metformin. But should I really? If the number of "me's" was only 10 and one had a random increase in castration resistance time due to his genetics, his diet, his exercise, or whatever and the others didn't, then it might appear that metformin provides a benefit for N1 APC. Is that real though? I'd like it to be but without more data, I think it's wishful thinking. But do I have time to wait for better data to come along? My APC isn't waiting around so perhaps I need to do something now. If the risk is low, and the cost is low or zero, and there is some possible potential benefit, should I really wait around until either, a) I'm dead, or b) better data is presented to me?
The second study states that all of the subjects had a high BMI. Well, that is so not me unless they were all weightlifters or athletes which I doubt. How does this affect the results? No effect? Positive effect? Negative effect? I could throw out theories for each case. But which is true?
I'm not on bicalutamide or ADT. Another issue. How do I relate the results of the first study to someone who is not doing either of these? Does metformin work for PCa only in conjunction with testosterone? I'm not saying it does or it doesn't but these studies don't give me an answer to that question.
In the METAb-Pro, they state that 12% didn't have progression but they had decided to set the bar at 35%. Why? Did they have a control AA group? What percent didn't have progression in the control? What was the average progression and what was the resolution of the PSA test they used? And what was the starting point for the subjects? Did the 12% have progression prior to metformin/AA and none after? Or was their PSA flat beforehand and flat after?
And another problem with many of these studies, RCTs, prospective, retrospective, case histories, you name it, is that they typically only look at one or maybe two or three different things at a time. Perhaps metformin is effective if it is combined with exercise, dietary changes, a statin, aspirin, etc. Do these trials tell us this?
I could go on and on and on, but I think you get the point.
I deliver the science - if you want to ignore the science, and feel in your heart-of-hearts that YOU are the exception, that is certainly your decision to make. Each prospective trial targets a particular group. If you aren't part of that group, it doesn't apply. Why is there even a question?
The reason these small trials are done is that most drugs have no effect. A Phase 2 trial is a screening tool. Otherwise, we would waste a LOT of time and money on drugs that do nothing. If you've heard of Baysian statistics, these small trials set limits on what will be found in larger trials. In general, they are not pursued (although STAMPEDE is a large, long f/u trial that is pursuing this.
If you are N1, why are you messing around with metformin? Why aren't you pursuing curative therapy?
A drug, like metformin, isn't effective just because you feel it is, it has to be proven effective. Without proof, why would you take a non-effective drug?
BMI was a parameter because metformin is given for metabolic syndrome, and men taking ADT are more likely to get metabolic syndrome.
They set the bar at 35% because on that sample size, it would not have occurred by chance. I gave the link for the study - you can answer those questions for yourself.
There is a trial of metformin+ statin. That's why I listed them. The problem you have is that science is confronting your confirmation bias. Otherwise, you wouldn't give it this much emotional baggage.
Same old TA. Some people are incapable of change.
I've come 180° on metformin. Some of us change when we see better evidence. I guess you're stuck.
Stuck living large! And I do mean living. And I do mean large too. Thanks!
TA says, "Each prospective trial targets a particular group. If you aren't part of that group, it doesn't apply. "
The default assumption is that if you ARE part of that group, then any conclusions necessarily DO apply.
But even if you are part of that group, you have no way of knowing what other relevant factors might further differentiate individuals within groups of men that are highly heterogeneous. Different sub-groupings may give different results.
In other words... Best Evidence So Far: Metformin Has No Benefit for Prostate Cancer in a Very Small Number of Men Studied Over a Very Short Periods of Time in Groupings That May or May Not Overlook Important Sub-Groupings.
Lol! That is one of the reasons I shrink away from SOC. My experience is that they love to fit things in nice little bins in a one size fits all approach. It never ceases to amaze me how little they seem to know about statistics, how blind they are to individual desires, how they do not seem to be able to think outside the box, and how they don't want to acknowledge the fact that a large portion of things that they "know" will be overturned in the future.
Before one thinks that "I am the exception to this rule," it is better for one's health to think, "what if I am just like the typical patient?"
The more you believe you are exceptional, the more you put yourself in the dangerous position of putting your personal intuitions above science.
If three lottery tickets are sold at $1 for a prize of $10k, the winner will be "the exception to the rule" that most tickets sold are losing tickets. So it is better for one's wallet to think, "what if I am just like the typical ticket holder?" and save your dollar.
Potential costs and definite costs should always be weighed against potential benefits and definite benefits. That needn't have anything to do with intuition.
Sure, buying that lottery ticket is no more a "retirement plan" than metformin monotherapy is a "cancer plan." But then, I doubt that a single person on the planet has ever considered metformin monotherapy as a "cancer plan." So you probably needn't spend much time warning against it.
LOL- I worked for the lottery. We sold lottery tickets as entertainment - for a buck, one can have a moment of fantasy. Anyone who thinks buying a lottery ticket is a good investment is certainly deluded. If anyone wants to use metformin or statins or aspirin or pomegranate juice because it helps them fantasize that they are doing something for their prostate cancer, they are similarly deluded - the evidence so far doesn't support it. There is probably not much harm (except for one trial and prevalent contaminants), but to refrain from looking at the evidence is foolish.
You are referring to "the lottery" and "lottery tickets" as commonly thought of, entertainment, and I agree -- one chance in millions, to get millions, is unrealistic. Yes,for a buck, one can have a moment of fantasy.
But that was not my example: is a 1-in-3 shot at winning $10k really not a good investment? Is one who takes those odds certainly deluded? I could honestly say I don't know a soul who wouldn't make that bet.
I do not think the odds of metformin having SOME beneficial effect are as good as 1-in-3, or as bad as one chance in millions. I have no good idea of what the odds are for ME, which may or may not be what the odds are IN GENERAL (which admittedly now appear lower than they previously did, and I do not fault you for providing that evidence, which in itself IS a service).
That the evidence so far doesn't support it does NOT necessarily mean one is not looking at the evidence by continuing to take metformin; it could simply mean one accepts that as evidence but does not see it as conclusive proof, and still sees POSSIBLE benefits as potentially outweighing both known and possible costs (including contaminated meds). Such a calculation being "foolish" is in the eye of the beholder and not definitively so, because, as you admit, there is probably not much of a cost.
Is there no danger? What do you think about this?
clinicaloncologyonline.net/...
What I think is THIS study is "opposite to PRIOR STUDIES showing superior prostate cancer outcomes in patients receiving metformin" and that BOTH this study and some opposing studies are good supporting evidence when weighing potential costs and benefits.
But saying there is NO cost, definitively, is different than supposing "there is probably not much harm." One is not necessarily claiming absolutes, but comparing LIKELIHOODS of potential costs and benefits. Of course one is going to be biased towards believing what one WANTS to believe, and that will influence how one weighs evidence.
We would all LIKE to believe a glass of red wine or a square of dark chocolate has more benefit than cost... unless we happen to hate those foods!
As someone else pointed out (perhaps in this thread) the mainstream consensus sometimes uses evidence (perhaps called "proof") that is later shown to be flawed or misinterpreted. A good example would be the policies that shifted diets towards higher carb intake by way of demonizing all dietary fat.
These arguments seem often about individual views of whether "the jury is still out" or the verdict is in.
One has to be wary of confirmation bias. It's a natural instinct.
If one looks at small (Phase 2) RCTs as screeners (which is the way the scientific community does), trials that show no benefit screen that intervention out, while trials that show some benefit, allow the intervention to pass to a larger Phase 3 RCT.
Observational studies are only hypothesis-generating because they are so often contradicted (in contrast, high GRADE, level 1 evidence has never been contradicted). They are only used to decide whether a Phase 2 trial should be done. But well-done observational studies that show safety hazards have to be taken seriously.
Fortunately for those who believe in metformin, there are two Phase 3 trials in the works (newly diagnosed metastatic and active surveillance).
"A drug, like metformin, isn't effective just because you feel it is, it has to be proven effective. Without proof, why would you take a non-effective drug?"
So much cluelessness in your comment that... well, I'm speechless.
TA seems to be saying something cannot be effective until AFTER that effectiveness has been proven, which makes no sense. By the logic of this sentence, meds are ineffective until a study renders them effective, LOL.
Of course, this is not what he is trying to say, but I think what he fails to accept is that a lack of proof of effectiveness is not proof of ineffectiveness.
If there is evidence that a non-SOC might be helpful, he calls that evidence; if there is evidence that a non-SOC might NOT be helpful, he sometimes calls that "proof."
Evidence that is "statistically significant" is just another piece of evidence. I have no problem with his claim that these studies are evidence of PC ineffectiveness, because they are. But I will weigh that along with both 1) mechanistic evidence, and 2) the low potential for harm and high potential for other benefit.
If nothing else, metformin may only be a cheap and harmless PC placebo that has non-PC benefits, and I'm okay with that. But it may also have PC benefits, for some men, that don't lend themselves be obviously apparent within the confines of some individual studies.
Rather than inferring what I "seem to be saying," and setting up straw-man arguments, it might be more useful if you would address what I actually said.
"Proof" in medical science means level 1 evidence.
"if you would address what I actually said"
Okay: you said metformin IS a non-effective drug. Now prove it, with proof?
You are welcome to redefine "proof" as "evidence." As a high priest in the Church of Statistical Significance, this is of course essential to the religion: words used within The Church do not need to mean what they mean everywhere else in the real world.
If The Church cannot find, in its first few meager tries, statistically sufficient evidence of existence, it considers that it has "proven" nonexistence.
All of the randomized clinical trials of metformin so far (collective sample size = 333) are consistent in showing metformin has no effect on advanced prostate cancer.
Yes, and I can agree that is good EVIDENCE. But I will not call it proof. If "proof" in medical science means level 1 evidence, then you could have titled your post as "Proof: Metformin Has No Benefit for Prostate Cancer."
I might add, medical "science" does not always apply to medicine as practiced, as many surgeries never get subjected to the same rigorous (and expensive) demands of level 1 evidence that new drugs do.
Proof can only be definitively established by a randomized clinical trial. That was a lesson of the scientific revolution. No need to reinvent the wheel. But what of cases where proof cannot be established by an RCT for ethical reasons or because it would be impractical? This is the case with smoking. It would be unethical to tell a random sample of people to smoke, and it would be impractical to watch them for 20 years to see if they developed lung cancer. In 1965, Sir Austin Bradford Hill came up with a set of criteria that have been widely adopted. Here is his seminal paper, if you are interested:
You are "speechless" because you have consistently failed to come up with any useful comments on the topic. Perhaps you have something useful to add to the conversation, but all you're putting out is a very desperate emotional response and ad hominem attacks.
I'm not trying to defend metformin. I am simply noting your character. My comments are direct attacks on You. The best I can do from a computer is to let you know what I think of you.
Your assessment of my character has no relevance to a discussion of treatments for prostate cancer. Such ad hominem comments (look it up) are best left to yourself. Why on earth would I care what you think of me?
Here’s the real truth .... nobody has a clue
Some drugs work for some and not for others
The wonder drugs of xandi and Zytiga (on average) extend life for 3 months
So go a lot longer and others don’t
Take metformin and roll the dice
Hope you get lucky
Well, we do have a clue- that's what science is for.
Ask 10 experts who conduct 10 trials and get 11 different outcomes 🤦🤦🤦
That's not what happens with RCTs - that's what happens with observational studies. It's why we do RCTs.
Really? You seriously want us to believe that RCTs NEVER conflict? What color is the sky in your world?
I'm siding with Tall Allen on the science. When I was first diagnosed with PC I believed the internet which said pomegranates killed PC cells. So I wasted a lot of time and money procuring the juice. Then my psa went up. Six months later WITHOUT the pom juice my psa was almost normal. So there wasn't even a correlation between my psa and pom juice , much less cause/effect.
I believe eating healthy is good and I believe in randomized clinical trials/studies is also good.
Large well-done (high GRADE) RCTs never conflict. That's why they are the gold standard. I've seen conflicts in smaller subgroups, or because the patient characteristics were different, but never in whole. Find some!
And leave the snarky comments and ad hominems outside - some of us want a civil discussion on issues important to us. If you have anything useful to say, I am certainly willing to discuss it.
You have a computer. Do I need to help you read or type the search words?
Even if I showed conflicts to you, you would come up with some nonsense to "prove" that you are right. You remind me of the people who fell for the vaccines cause autism scam perpetrated by a doctor in the 90s, and now are incapable of changing their minds.
You may have the last word now. Since it is the Christmas season I'll give you that as a gift.
You are kidding yourself that anything you are doing even remotely resembles science.
Damn, the "simple man" is o-u-t. Batter up!
Lego is the way to go. They cost 13 times as much as the Lincoln Logs. Probably just the marketing. I give the 2,000 piece sets to the kiddies for X-Mas. Parents despise me. They get so much exercise picking them up, I should be getting thanks. But no. All they think about is when they step on them and scream. I am a prophet in my own land and get no respect.
Some times do get a little personal and derailed, But each of us is different and drugs affect each of us differently--I can attest to that after having very bad reactions to some of the drugs that work great for other members here, Peace be with you, and I'll not comment to the main posters in this post. Best of health ot you all..
The post seem to go south when instead of science its opiniopns or a good outcome one had for themself....like those of us who take double blockades and can barely walk while others run and bike their happy asses off....thanks to ta and nal for the help they give...to whimp, kaliber, and others for compassion....merry christmaz.....happy hannakah .....and may we all get better....peace brothers in arms ..b.w.P.s....if you dont stand for something....youll fall for anything
It is ridiculous to say that you use metformin "successfully" - how could you possibly know that? Did it bring anyone's cancer into remission? If so, the case study would have been reported - it wasn't. These prospective trials are the highest level of evidence ever reported for it. Each is small, but taken together they paint a consistent picture. Also, the lack of a plausible mechanism further erodes confidence. You are operating on much weaker evidence, which isn't evidence at all. Throwing a bunch of non-effective drugs at it is no evidence, and neither is a compilation of observational studies.
I suggest you send the article to a real MO for comment.
Do you mean the real MOs who didn't even know the simple feedback mechanisms of estrogen and LH and Leydig cells that would take T low if exogenous E is administered? I'm still SMH over that one. I visited four of these supposed experts. None of them seemed to understand basic biology.
Send it to them for comment? Why? First, you'd need to train them in High School biology. Then college. Then University. Then perhaps train them in data analysis and statistics (REAL understanding, not the simpleton understanding displayed by most people who "think" that they are smart). And after years of training them perhaps get an analysis that you could make that day?
Perhaps you need a better MO. Where do you live? I can possibly recommend someone.
Two nationally renowned Doctors at Mayo Clinic (one urologist and one oncologist - I can't excuse the urologist for not understanding High School biology even though hormone interaction isn't his primary field). Two other doctors at clinics that are not as well known.
Hobbits: no beards, no fat, no shoes. I don't think they're allowed on this site.
J-o-h-n???? Let's see. Beard, fat, no shoes. I'm sure he will be chiming in.
Good exit. 9 ways to take that innuendo. I'm not even going to comment.
Has anyone noticed that the abusive comments and personal attacks here come mainly from those who oppose supplements and alternative approaches, even when used as an adjunct to SOC? I love my SOC, but I am going to happily keep using my “supplements” because my admittedly statistically insignificant evidence is that they make me less likely to act like an a-hole. Peace out, brothers.
I've noticed the opposite. All of the abuse is coming from true believers who think that actual evidence that challenge those beliefs can't possibly be true and must be part of a plot. Comments related to the subject are always welcome, pro or con, but personal comments like yours have no place in a civil forum..
Brings me back to high school. He started it, no she did, no he did, no...
In all seriousness, I blame some of it on ADT and other treatments. We're just not used to having zero testosterone. Women have a lifetime of having low (but typically nonzero T) and they have learned how to handle it. We haven't. So people go ballistic and it really isn't them. It's the stupid ass treatments that we have to do. Perhaps it's zero T, or high T, or some other crap, or just the stress of having cancer and all the horror that comes with it.
You can read the posts of some of these guys and you'll see that most of the time they are reasonable, rational people, and then sometimes they go crazy. Calling someone simple is an example. LA typically seems like a very normal, rational individual. But the shit he has to go through made him throw in a negative comment. And then XP responded. XP and I did the same thing a while back. Stupid and not us. It's our miserable therapies screwing with our minds and our emotions.
There is one guy on here who just seems to be a negative, hateful person. You can probably guess who I mean. I don't think it's cancer that makes him that way. Perhaps he has a horrible life or had a bad childhood. I don't know.
I was going to give these guys one last tweak, but your post dissuaded me. The purpose of this site is giving and getting knowledge and support. I suppose we all know who does that constructively and who doesn’t. Happy holidays.
I study the work of actual scientists - not people who repost here. People like Patrick refuse to acknowledge that there are levels of evidence ( although I have given him references), so he draws erroneous conclusions based on observational studies. I hope he learns to understand the difference.
People who use themselves as human guinea pigs can do a service by joining an actual clinical trial (as I have done) where they will be closely monitored, and everyone will benefit. If there is any effect, it will only be discerned by the power of randomization, not by individual claims. Sadly, many of the metformin trials have been canceled due to low accrual -- And then I read huffy complaints from patients that only Big Pharma tests drugs. There are some clinical trials listed.
You may not know anyone dying of metformin, but there have been many recalls over carcinogenic impurities, as I wrote.
"Pseudoscience is popular because it confirms what we believe; science is unpopular because it makes us question what we believe. Good science, like good art, often upsets our established ways of seeing the world." —Carol Tavris, social psychologist
I take metformin to prevent diabetes. If I didnt, my blood sugar would go thru the roof on ADT and I would progress to diabetes. If you have high blood sugar on ADT, there is absolutely a benefit and a survival benefit by slowing diabetes progression.
"As for the pharmaceutical profits, today's drugs pays for tomorrow's research, do you have a better solution? I'd be interested in reading it."
Pharma is the highest profit industry in the world. This is primarily because of government intervention that distorts natural market forces.
And research money isn't going where it needs to. For instance antibiotic research is being starved.
There are numerous proposed solutions. Just off the top of my head.
1. A slight modification to price discrimination laws to cut pharma exemption to them.
2. Hey, how about letting the government negotiate the pharma prices it pays.
3. You ever try to price shop your meds from pharmacy to pharmacy but you can't get the insurance adjusted price? Why do you think that is pretty much impossible?
4. If they benefit from government subsidized research, they should be prohibited from using their profits to buy laws and politicians. That would include research from non-tax paying institutions.
5. Prohibiting dark money pacs would be a simple healthy elixer. Though technically both sides use them, they disproportionately benefit large corporate interests and the politicians in their employ. Doing so would dampen big Pharma's ability to buy laws that enable it's dysfunctional behavior and pricing.
There are many other proposed solutions.
But basically it is an artificially distorted market that is the ultimate source of the problem.
Is that an adequate answer to your question?
PS: Remember the "Pharma bro" now doing time in jail. How about a law making it illegal to pardon him? LOL
Since I became eligible for Medicare, I've become a strong advocate for letting Medicare negotiate prices for drugs. In this respect, it's like Sisyphus rolling that boulder uphill. I know what he did to anger Zeus to forever roll that rock uphill but I don't even belief in Zeus. Yet I feel exactly like Sisyphus. I suspect this is how "they" continue to beat me by wearing me down.
All I'm saying is once you try to tame a dragon, keep an eye on its breath.
😐
"He randomly selected himself for his trial but he never mentions who is in the control arm."
Yes that's a problem. There is no shortage of irrational self destructive behavior out there xpo1.
Just take a look at the dysfunctional and irrational behavior in certain countries with respect to Covid 19.
On one side you have the shameful and embarrassing behavior, death rates and economic destruction in the US.
Then you look at the more responsible and responsive behavior in Australia, New Zealand, Taiwan, Korea, China, even third world countries like India.
Why do you think that is?
I answered your question.
The multiple gratuitous ad hominem was neither welcome nor appropriate.
You need to loosen up a bit. Chill out. There is no need for all the anger. Probably not good for anyone's pca.
The last part about pharma boy was nuanced humor. If you read it again, I think you will get it.
I’ve been taking it almost since dx nearly 7 years ago part of the Snuffy Myers regiment. I’ll continue to do so. Even if it does nothing for my PCa it has helped me avoid metabolic syndrome and maintain a normal BMI despite being on ADT all this time. And I can’t argue withe the results of the Snuffy regiment.
I wouldn’t stop or start anything based on such a small sample. Metformin is safe, cheap (free at Publix) and I have no side effects.
I suspect a “click bait” post.
Ed
"I wouldn’t stop or start anything based on such a small sample. " A meta-analysis of all of those RCTs has a sample size of 333 - all saying the same thing -- no effect.
"Even if it does nothing for my PCa it has helped me avoid metabolic syndrome and maintain a normal BMI despite being on ADT all this time."
But the actual evidence is that metformin does not do that: ascopubs.org/doi/abs/10.120...
"I suspect a “click bait” post."
It can't be click bait, since I make no money off of it.
I’ll stick with the advice of my excellent doctors and their continuing review of the meds I take. If they tell me to stop, I’ll stop.
Based on the title of the post I still call “click bait” for whatever the reason.
Take TA for what he is: entertainment.
RSH1, are ad hominem attacks the best you can do? That is what one resorts to when one has no real arguments.
And, believe me, we do read. And we appreciate what you contribute.
Personally, I believe that metformin, statins, exercise, diet, hormonal therapies, etc, etc, etc, etc, work in conjunction. Do they all work separately? I doubt it. Do some work separately? Probably.
And as my doctor told me two years ago: "if you are doing 20 things, and each, on average, provides a 5% absolute benefit, then you are done".
"There is no point in beating a dead horse."
Good. Then I shall take the last word
In the process of insulting someone, you posed a question. Said you would welcome an answer.
I gave you several. I could supply you with more.
It is sort of unfair for you to ask a question, then bite the hand that answers it.
Take a deep breath, then count to 10.
Thank you
First: "Do you have a better solution? I'd be interested in reading it."
Then: "I never asked you a question so I really don't care about your response."
LOL, I guess its true that he didn't ask YOU the question. Perhaps only LearnAll could have solutions worthy of any interest!
As for me, I agree with many of your points, and thought it WAS an interesting post. It is curious how many bash the "free market" for medicine when we have had nothing remotely resembling a true market for many decades.
Dr. Myers put me on metformin several years ago. Regarding Science and scientists, I think he ranks pretty high as former head of Oncology at UVA and additionally he was a Pharmacologist. With Gleason 9, Following his advice has kept me alive and relatively healthy for 17 years. I believe that all cancers are individual, impacted by individual DNA, experience and even mental make-up. Think it would be foolish to follow online medical advice over that of an excellent and practicing physician. My new Oncologist from Anchutz has no problem with my continuing with the Dr. Myers protocols as they have given excellent results
I now see Dr. Sartor at Tulane who is Snuffys replacement as my PCa specialist. Sartor is one of the top docs in the field and is very data driven. He has had no problem with metformin or any part of Snuffys regiment. I’ve been seeing Sartor for over 3 years now.
Ed
"No problem with it" is different from saying it actually benefits you.
Well they write the prescription for it so they must feel there’s a benefit, I’ll wait for your response since having the last word is very important to you.
Did you notice that too? TA has to have the last word. The only time he doesn't is when it is noted that he wants the last word. Even then he frequently can't help himself.
I like having the last word also. But I admit it openly. And I hope that I'm not as desperate in seeking validation as TA.
Several years ago, we didn't have the information we have now.
This up to date review appears to give a balanced view. The abstract and conclusions are given below.
Current Status and Application of Metformin for Prostate Cancer: A Comprehensive Review
by Hyun Kyu AhnOrcID, Young Hwa Lee and Kyo Chul Koo *OrcID
Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, Korea
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2020, 21(22), 8540; doi.org/10.3390/ijms21228540
Received: 30 September 2020 / Revised: 31 October 2020 / Accepted: 9 November 2020 / Published: 12 November 2020
Abstract
Metformin, an oral biguanide used for first-line treatment of type 2 diabetes mellitus, has attracted attention for its anti-proliferative and anti-cancer effects in several solid tumors, including prostate cancer (PCa). Liver kinase B1 (LKB1) and adenosine monophosphate-activated protein kinase (AMPK) activation, inhibition of the mammalian target of rapamycin (mTOR) activity and protein synthesis, induction of apoptosis and autophagy by p53 and p21, and decreased blood insulin level have been suggested as direct anti-cancer mechanisms of metformin. Research has shown that PCa development and progression are associated with metabolic syndrome and its components. Therefore, reduction in the risk of PCa and improvement in survival in metformin users may be the results of the direct anti-cancer mechanisms of the drug or the secondary effects from improvement of metabolic syndrome. In contrast, some research has suggested that there is no association between metformin use and PCa incidence or survival. In this comprehensive review, we summarize updated evidence on the relationship between metformin use and oncological effects in patients with PCa. We also highlight ongoing clinical trials evaluating metformin as an adjuvant therapy in novel drug combinations in various disease settings.
Conclusions
Contemporary standard treatments for advanced PCa are limited by drug resistance and toxicity. Therefore, new cellular targets and novel molecular therapeutic agents with favorable toxicity profiles are needed. Metformin exerts direct effects as a metabolic homeostasis regulator and indirect effects as an anti-proliferative and anti-carcinogenic agent. Considering the potential association between metabolic syndrome and PCa development and progression, metformin may be considered an adjuvant agent, both as a monotherapy and in combination with other therapies. Studies have reported conflicting results regarding the association of metformin use and the risk of PCa incidence and survival outcome. Ongoing trials are exploring the additional effects of metformin combined with androgen receptor axis-targeted agents in patients with CRPC and patients receiving salvage RT following RP. Overall, the relationship between use of metformin and PCa remains controversial. Additional studies are warranted to validate the clinical benefits and potential risks of metformin use. Studies to explore the optimal strategy to maximize the benefits of metformin’s intrinsic proprieties are necessary, as are studies of metformin’s pleiotropic effects, especially those related to reduction of serum glucose and insulin concentrations.
"There is no point in beating a dead horse." XPO1"I'm going to provide a final post..." XPO1
XPO1, you said those two things in the wrong order.
Your last post is just so factually incorrect, and misleading on so many levels.
I will just pick one.
The Pharma bro proved what is well known in the industry, the generic market is not a free market. It's just slightly more free than the regular Pharma market.
I would encourage to do a search on Dunning Krueger.
I would submit pretty much every sentence in your "final post" contains material errors of fact and assumption.
With only one possible questionable open issue. Whether this is in fact your "final post".
I think likely not, but I can't say so with any certainty.
Thank God, I don't take orders from you. I don't even see any of your ridiculous posts unless you respond directly to me, as you have done here.
It is ridiculous that you think I do not keep up with current research on immunotherapies and other cutting edge therapies, and I have always been very supportive of clinical trials. What I will not advocate, as you do repeatedly, is taking drugs, sometimes dangerous ones, outside of closely monitored clinical trials.
If you want to practice voodoo on yourself, that is certainly your option. I'll stick to science.
On the other hand I would prefer you take your posts to me private. At least the angry resentful ones.
Don't forget, at our age, none of this is really that important is it?
And if you have something to say to me only, please say it in private.
Thank you
I appreciate the post for what is 'documents' and that is the lack of proof under the circumstances that set the criteria and the lack of solid evidence to make 'blanket' statements about a given supplement / drug or chemical formulation.
You certainly provoked a response - and that is fine with me - I've read enough of the posts over the last few years to understand the different perspectives that many of the individuals on this site have to offer - the good and the no so good.
I personally started metformin for a few reasons - the primary one was that I had TWO markers that make me pre-diabetic so my GP agreed that this would likely benefit THAT situation. I also pointed out to him that many PCa patients were taking metformin for a variety of reasons and that MAYBE there might be an advantage for someone like me to take it.
I'm less advanced than some and have seen some good results continue for me - especially when it comes to insulin resistance - one of my markers that was showing a problem.
My blood work has shown signs of improvement, so for me - I'm going to continue with it.
Let's hope that further study will be more definitive - but it appears that there is not enough evidence to draw a final conclusion - but I wouldn't BANK on it that consumption of it as being a MAJOR factor in slowing progression .... there needs to be a controlled study without 'bias' to make things clearer for anyone that has justified doubts - one way or the other.
Thanks for all that you try to do - when it is clear that some don't see it your way. I always try to weigh the comments and studies that you point to.
I look at everything with an open mind - all that I can read up on and try to sort it out as best as I can .....
Science in medicine dates back to Francis Bacon in the 16th century. Randomized clinical trials were used as early as citrus for scurvy in 1747 by James Lind - far older than 70 years. The process worked then and it works now.
Have you known of one cheap drug that is ever brought forward as new treatment?
Your initial post did seem almost gleeful that a study supposedly found metformin ineffective.
Let's leave metformin aside for the moment. Was there a randomized double blind clinical trial before they starting adding iodine to salt? The science says that iodine deficiency can lead to goiter and other problems. Was there a clinical trial to prove that? How dare these bastards enforce iodine supplementation on the populace without their consent, in the form of iodized salt? As the hater of supplements without proof of benefit what say you on this particular supplement -- iodine?
Yes, RCTs certainly have been done on iodized salt:who.int/elena/titles/review...
pubmed.ncbi.nlm.nih.gov/126...
pubmed.ncbi.nlm.nih.gov/104...
ign.org/cm_data/1999_Zhao_R...
academic.oup.com/ajcn/artic...
clinicaltrials.gov/ct2/show...
(many more)
In fact, you may be interested to learn that the first known RCT was done by James Lind in 1747. It found that citrus cured scurvy.
We're all in one-person clinical trials in a sense.
I'm reasonably sure my oncologist would have preferred that I continued with ADT but he respected my decision to stop almost 4 years ago due to severe side effects.
He also respected my decision to continue taking Essiac tincture and CBD oil, even though he assured me they wouldn't help at all.
Now, almost 4 years later, I'm doing fine with an almost flat PSA trend line for almost 4 years and my 2020 PSMA PET scan showed marked improvements over the PSMA PET scan taken December 2016.
My oncologist keeps telling me to "keep doing what you're doing" too.
I've been another "One person trial" for almost 4 years.
Does that scientifically prove anything?
Of course not.
But .... to me it does suggest that the things I've been taking just "might" help someone else.
Merry Christmas to all.
Dave
This has been the best pissing match since the last political blog I read. Thanks, Gentlemen. Nothing like the full exercise of freedom of speech.
Oh-anyone heard anything lately on Dypiridamole?
When you're metastatic you tend to try many things that might work.
I want the last word. What were we talking about? Oh, a tempest in a tea pot. No, no, I didn't say anything against tea. Thanks to all for the entertainment. I hope I didn't offend anyone; but if I did, you probably deserved it. Enjoy.
No i get the last word andits.......supercalifra......i forget....wheres j.o.h.n. when you need him.......
No I get the last word. I wonder how much room they have on this server? I last saw
j-o-h-n in a kayak going east on the Hudson, better known as The Rat Toilet.
My general rules are that I resist the idea that any one thing is the answer. Must be reasonably priced. I must see no adverse effects and must see progress to continue. I rotate some supps in, some out periodically. I eat WFPB diet, no alcohol, processed products, soft drinks, artificial sweeteners. Haven't done IV-C or COC, although I'm open minded on both. I resist pricey proprietary supplements and often try to eat whole food versions of the supps, like turmeric/curcumin.
I've also been on Lupron for two years.
I don't think either church has the complete answer, but I see no problem with cautiously exploring both. We only have one life and limited time.
** To hear the ditty just click on the title... **
youtube.com/watch?v=YhBgJUX...
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 12/17/2020 6:48 PM EST
It was so bad I fell asleep after 10 seconds!!!
Well just think..... you've got left over popcorn.....
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 12/17/2020 6:58 PM EST
No I ate it in a JIFFY
Hog.............
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 12/17/2020 7:12 PM EST
I once metformin on a construction site who told me "know why I called you in here". I replied "cause I accidentally sent you a dick pic?" Foreman, (stops pouring 2 glasses of wine) Accidentally?
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 12/17/2020 7:24 PM EST
Especially on the diet your on!!!
Yea sometimes the quick comeback yields little humorous response...Jiffy Popcorn not an essential for ones good and healthy diet...I know I stretch the humor especially dealing with our master j-o-h-n!!!...😊
Sleep well without Metformin 😂
But we did learn that the way to perform science is:1. Have a theory
2. Find studies that support your theory and ignore the ones that contradict you.
3. Write an article that references the support.
4. Rinse and repeat to prove whatever theories you might have.
Belittle anyone who doesn't agree with your "science". Send them to your blog post for "proof" of their errant behavior.
RSH1 - I can see you are getting defensive. I hope that after some time, you will come to understand that nobody is born knowing all these things. It took me 20 years working in research to accumulate the knowledge that enables me to correctly interpret research. Compared to someone like Andrew Vickers at MSKCC, I know that I know little - I would always defer to him, and hope to learn from him. No one expects you to know these things. You may find that a little humility about how much there is for you to learn will, in the end, help you to make better health decisions.
This has been a fascinating chain. When a person has a disease, as unpredictable and potentially scary as prostate cancer, it gives some solace to hold on to a theory or “new” hopeful treatment. We, humans, do this.
We do not know the correct path for the treatment of prostate cancer, we can only follow the best at this time. I “ believed” in metformin and had diarrhea for two years. TA is correct. Follow the science, and your odds will be better, and in my case, no diarrhea.
If I eat kale daily and my PSA stayed undetectable, you may find me writing about the importance of kale. If I do, I hope a writer in this column corrects me, before someone gives up a scientific treatment for kale.
Being notoriously cheap, I myself only pursue longshots when they appear safe AND inexpensive. But of course, that is their money, and their choice.
One might also claim it seems absurd to spend several THOUSAND a month, of OTHER people's money, on various treatments that for some individuals might actually not end up being much benefit. This world is filled with unneeded or ineffective treatments both within and outside of mainstream medical systems (obviously with the greater number falling outside, but the point remains).
Whether it is insurance or socialized, third-party-payer has become THE driving force in rising costs of care, and the disconnect between what patients might want/need/get and what they could actually afford for themselves.
The hospital where my wife works routinely does (as I recall) a within-24-hr stroke protocol for patients outside of that time window. Why? Because they can get away with billing for it. It is not the patient's money they are taking!
But what does "to insure against high cost treatments" really mean? You are not insuring against high-cost but only against YOUR burden of that cost, so that the burden is shared. Part of the REASON that costs are so high is the nature of sharing their burden under highly regulated and subsidized systems.
You are exactly right that the majority of outright fraud is in the government run healthcare, but it helps dive up ALL costs of care, as government run healthcare is an integral part of the overall system and itself helps drive the evolution of standards of care and how care is "priced." It is priced artificially high and then "discounted" in various ways that lack any transparency and consistency (per supply and demand of a true market).
Thanks... yes, sorry that was really a change of topic. A digression from simply pointing out that "standard care" can also be somewhat of a lottery ticket (with much better odds) that is far more costly then supplements, even though that cost is not all directly incurred by the person getting treated.
Prostate Cancer Patients Shouldn't be so Quick to Dismiss Metformin (despite some contrary opinions on Advanced Prostate Cancer forum)
Metformin Possibly Beneficial in Advanced Prostate CancerMetformin: Preliminary Results of Trial in Advanced Prostate Cancer (MANSMED)
Metformin Use Is Associated with Improved Survival in Patients with Advanced Prostate Cancer on Androgen Deprivation Therapy.The impact of metformin use on survival in prostate cancer: a systematic review and meta-analysis
