Are you on ADT? Many/Most of us are.... - Advanced Prostate...
Are you on ADT? Many/Most of us are. THIS IS A MUST WATCH VIDEO. 3 key points: Statins, Degelrix, Metformin. Grand Rounds in Urology.Mike
Bad link
I am able to see the video directly in the post. Maybe it's a region thing?
Mike,
Good find.
I asked my doctor for high-dose Simvastatin 13 years ago. (All my meds are PCa-related.)
He wouldn't give me Metformin, but I got it from my integrative medicine doc.
Klotz mentions the alternative pathway for DHT that does not involve T. That's why I asked another doctor for Avodart over 10 years ago.
This is just to demonstrate that a case for all three could be made over 10 years ago.
I don't think Alendronate is a good idea if low dose estradiol [E2] patches will prevent the rapid bone loss that can occur with castrate T. E2 is the problem (not T) - should not go below 12 pg/mL.
I once told my integrative guy that I viewed PCa as another symptom of MetS, & Klotz come close to saying that.
Degarelix is certainly worth considering.
Good speaker - covered a lot of ground lucidly.
-Patrick
Super interesting! Seems we should all be on statins and metformin if we're on ADT. And switching from Lupron to Relugolix sounds like a wise move to reduce cardiovascular risk.
Bean, you heard what I heard and got the same thing out of it. I just switched from Firmagon to 3 month Lupron. My PSA seemed to do better Lupron though. One of my friends demanded Firmagon inject in butt rather than stomach and still had good result. Stomach inject takes a week to heal then 3 weeks until next.
My butt has no problem with the three-month shot 😉…but a daily pill sounds easily. I see my MO in three weeks and plan on discussing all of this.
If the injection is properly administered it is only 2 days of discomfort with say one day of fever. That is my experience with Firmagon over almost 28 months. I inject it myself.
Dr Lawrence Klotz is one of the greatest doctors and he gives very very good information. Its another excellent video from him.
Someone suggested taking his second opinion when we were considering surgery as an option for my husband but we did not go to him. There is also a practice restriction on him for certain type of surgery which put doubt in my mind about other surgeries. Even the big names are human after all. Also, this is not to say that his message in the video above is incorrect.
more info re Dr. Klotz's surgery restriction? Never heard of such a thing here in USA?
Thanks Spyder, I just got my blood work results and my cholesterol was 252, no bueno . I dislike more pharma but the statins could help ?
I’ve been on Lipitor for 15 yrs. no side effects.
All true, and should be well known by now to all of us on ADT. We absolutely cannot depend on doctors to tell us. Some won’t prescribe metformin, some won’t be even prescribe statins. Bone density loss we not likely to be warned about, nor diabetes. We usually won’t even be recommended to get a fresh lipid panel and dexa scan before starting ADT.
The most important by far is the exercise. 80% of people over 65 with a cancer diagnosis do no exercise.
My older friends often come back from checkups or other visits to their doctor’ offices happy that they were praised for their good health, which is often just the doctor telling them what they want to hear.
He often doesn’t even know the patient’s numbers, other than blood pressure and fasting glucose. They often don’t know his maximum heart rate, VO2 max, bone density, testosterone or strength or any other fitness markers.
So unless they detect something they can fix, actually recommending lifestyle change is not generally a conversation they are interested in.
They damn well should be.
The average BMI of a newly diagnosed Pca patient is around 30 now; that number has risen progressively for a long time as you an imagine.
So at a time of life when men need to maintain a healthy body weight and blood pressure, eat less sugar and refined carbohydrates, keep cholesterol and glucose low and exercise more, most are not doing any of this.
Against this backdrop they are then put on a drug that makes every one of these things worse.
Added to all of it is fatigue, making us not inclined to exercise, or do less of it.
If I could only take advantage of only one of the bullet points on his A-F chart, it would be exercise by a huge margin, because it has sizable benefits in every category.
Put another way, if I had to choose exercise only vs everything else on the list, it would be a very easy decision.
I cannot imagine and do not wish to know what my body would looked and felt like if I hadn’t worked as hard as I did while on ADT.
What we really need to be told before ADT is prescribed is this:
If we work as hard as we can, cardio and weights, we will still lose muscle, will still gain fat if we eat the same, will still tire more easily, probably will still get increased blood sugar, cholesterol, will still lose bone density, will still get fatigued, all of it.
Discouraging? It shouldn’t be, when compared to being sedentary. Walking alone isn’t enough either, healthy as it is. ADT overwhelms and deconditions the body with frightening speed if we do not intervene.
I know I talk about exercise too much on this forum, but I don’t care. I am more sure every day that it isn’t talked about enough.
Obesity and sarcopenia are epidemic as never before.
The addition of ADT to either or both of these conditions, at our ages, is cruel, and presents us with a very formidable challenge we must not ignore.
Well written London441. You get it. So much of this PCa business we cannot change. Exercise is one of those issues we can change.
Statins are something we can add
Metformin is something we can add
Switching from Lupron to Firmagon/Orgovyx-pill we can request
Alendronate 1x/wk, or E2 patches are something we can request.
Best,
Mike
I’ve been avoiding statins but I’m about to succumb. The diet I need to maintain without them at this point is just crazy strict. Metformin too, despite my blood sugar being in the healthy range.
I love that the Orgovyx is available, a subtle but strong game changer as you know. It wasn’t FDA approved when I started ADT. It surprised me a little that my T was still castrate level 8 months after my last Eligard shot, although it has recovered nicely since.
I never mean to say exercise is the only important thing, only that it’s super essential. Doing the rest of that stuff is great, but every guy should know the exercise makes all of it so much more effective.
There is a study recently circulating re men with higher BMI faring better than lower BMI re PCa survival?
I have heard of it, but it would have to be inherently flawed, simply because BMI is a unreliable marker. It doesn’t measure composition, only total weight.
This is why 2 men each weighing 200 lbs can have quite different ratios of fat and muscle.
Also, in late stage particularly, weight (and thus BMI) often drops due to the ravages of the disease. Not exactly conducive to ‘faring better’. Even if they control for that, it’s only one example.
To use BMI as a determinant of PCa survival is like using total calories consumed as a determinant of health regardless of diet.
This is not the first timeI've read studies about weight and health outcomes....seen similar study(ies) re older folks and overall medical outcomes, not just PCa. But I'm sure they were/are all worthless correlations. Yes, agree they could further study fat and muscle numbers...if they had such data? Overall, I'd just guess most of the higher BMI group have higher BMI caused by fat, not muscle......especially among older men. Generally , thinner folks will have higher muscle:fat ratio..IMHO.
Absolutely Maley. A good friend of mine was a funeral director for 45 years. He always said he never saw very old fat people come through.
I don't think any studies found that obese do better....having higher BMI does not necessarily include only the obese "very old fat people". Studies I've seen mention higher BMI folks in 10-30 lb overweight group ! Then again, of the many elder in my wife's church congregation when she joined 30 years ago, the only survivor in his late 80s is a pleasantly plump guy, and his over weight wife dies just a few years ago. Of course just anecdotal, and there were, of course, thin members who lived long lives.
I once saw a PBS piece on a group of vegetarian Adventists living longer lives than non-vegetarian Adventists. Conclusive??
Quite right BMI is just one indicator of weight and fat composition. It is not very reliable. I am more concerned about my total weight and fat on my abdomen then other parameters. For Diabetes I am strictly going by HbA1C. If you reduce your weight and keep some of your muscles intact you will lose some of that extra weight around the abdomen.
I have been taking Firmagon for 28 months. My experience is that with proper diet - reduce carbohydrates drastically and count your calories. I was able to reduce my weight by 9 pounds with regular walking, exercise, golf and minimize carbs and giving up sugar. I eat lots of fruit, salads and vegetables. I do eat fish or chicken twice a week. Protein requirement is met with soya products.
My BMI is now 21.5 against almost 24 when I started Firmagon. Reducing carbs reduces the Insulin production and minimizes Insulin resistance thereby reducing risk of Type 2 Diabetes. My HbA1C has come down from 5.6 -5.7 to 5.3. Just sharing my experience in case it helps.
Binati,First, congrats. You are posting better numbers than me. My weight battle is more like a war within a war.
Secondly, Dr Klotz is clearly saying that Firmagon is far easier on the entire metabolic check list than Lupron. I just switched from Firmagon to Lupron-3mos (opposite direction) , but will switch back after hearing this video. My PSA numbers did come down more with Lupron however. I may try the daily pill Orgovyx if insurance will not go thru the roof. Avoid monthly injections.
Nalakrats says dont wait for one pharma to figure things out and cause a failure. Stay ahead of PCa with early switches👨🏻🎓
Mike
Binati you are the man! I can’t conceive of controlling my situation through those means. Depending on what you mean by ‘exercise’ of course. Walking and golf would not be nearly enough for me. What else do you do?
I’m one of those that finds working out with great volume and intensity is a lot easier than caloric restriction. Yet it’s true we need both. Great job.
I do light weights at home since gyms were closed for a long time. Exercises are a mix of yoga and free hand stuff. Planking is a must for me. Have lost a lot of stamina in the past 2 years as well as at least 15 to 20 percent strength. In India we play golf mostly at temperatures between 35 and 42 deg C. In the rainy season humidity is around 70 percent or more. Golf on foot is an endurance exercise. It is great for a cardiac workout. I am 75 now and push myself as hard as I can.
How much harm would come from eating chicken 4 times per week and beef or pork 2 times per week.........beans don't agree with me, nor soy products.
I can't point you at any statistics from research right now but most of my reading has convinced me that reducing meat especially red meat and even chicken maybe good for PCa. However, if you want to have protein then maybe fish is the best as it is lean and you get Omega 3 and 6. My diet is conditioned more by Diabetes and a little less by PCa.
Very informative video thanks for posting it. I am on both medications so hopefully more ammunition against the Beast. Never give up Never surrender 💪 Leo
excellent, can't understand alot of what is said but enough to get the gist of it. Thank you
Golddiggingrandy,Listen a 2nd or 3rd time. I promise you will get more each time. The cost…$0.
Mike
thanks, I will
Maybe the COC protocol isn't all smoke and mirrors after all. They have recommended Atorvastatin and Metformin as part of their protocol since day one.
Kentucky, what is COC Protocol? Sorry behind the times. Thanks,
Mike
COC is the Care Oncology Clinic. They use a protocol based on the use of off label prescribing of older drugs in an effort to suppress the metabolic pathways of cancer cells. The 4 meds commonly used are atrovastatin, metformin, doxycycline, and mebendazole. They will also recommend other meds depending on the individual patient. A few of us on this website participate in the program. A few of our of our fellow members have called it borderline quackery. Check out their website and make your own determination.
True I was not high BMI but my family has a lot of diabetics including my late father and grandfather. Hence, much higher risk of getting type 2 diabetes. Will register for the resistance training session.
Statins and metformin are things Snuffy Myers was recommending around ten years ago or longer, once again he was way ahead of his time. They are both discussed in detail in his book, published quite a number of years ago. I started taking Metformin almost 8 years ago when I was first diagnosed after reading his book. My GP prescribed it after I explained the benefits, I’m not diabetic. I’ve been able to maintain a normal BMI while being on ADT the whole time. I’ve been taking a statin for years as well. After becoming a patient of his I ramped up the dosage of my statin per his instructions to get my cholesterol to a level he recommended then reduced the dosage because my cholesterol was getting too low which is not a good thing.
Ed
I have excellent blood lipid levels, glucose control, blood pressure, BMI 20.5. Should I still take metformin and statin? I don't find the evidence clearcut for this, even with my GS9, but I haven't checked that closely.
Purple Bike. I’m not qualified to answer. I would ask your oncologist.
Spyder 54, my oncologist will not prescribe statins because of my favorable cardiovascular numbers.
Following is the exchange I had with dr Hamilton, the lead researcher behind the study on the use of statins for prostate cancer patients, and his administrative assistant. As so often, not any clear-cut answer...
My questions: "The research by Dr Hamilton shows robust favorable outcomes with statin use for patients with prostate cancer on androgen deprivation therapy. My question is if there is data to state that the robustness of the findings is also true for patients with good to excellent cardiovascular status, lipid values, blood pressure etc".
Answer:
"I received an email forwarded from my admin assistant Kerry. You were asking about statins. There is definitely some exciting research that has come out and is ongoing in the field of statins and prostate cancer. Unfortunately, in my opinion, there is not enough evidence yet to convince us that all men at all stages of prostate cancer should go on a statin for the benefits to prostate cancer. For every ‘positive’ study there has also been a ’negative’ study that shows statins are no help at all. From our laboratory work we feel that even in men with normal cholesterol levels that there likely is benefit from statins - however this has not been proven in any clinical studies. Thus for now, in good conscience, it can’t be recommended per se. I hope that in the next 2-5 years that we’ll have more clinical trial data to help answer this question in a more definitive way.
I hope that helps a bit.
Rob
Robert J. Hamilton, MD MPH FRCSC
Staff Urologist, Princess Margaret Cancer Centre, University Health Network
Associate Professor, Dept. of Surgery (Urology), University of Toronto
Phone: 416-946-2909; Fax: 416-946-6590
Email: rob.hamilton@uhn.ca
I hesitate to add even more drugs to what I already take (abiraterone, Lupron, 3 different blood pressure pills, Flowmax). If already doing keto to counteract the insulin resistance, what's the upside of metformin? My understanding is that this drug is simply hiding the glucose within the fat cells storage instead of in the blood stream. Is that incorrect?
I've read everyone's comments that have been posted so far, but I don't think anybody else shared my reaction, namely, I was TOTALLY BLOWN AWAY! Because it made me realize that my medical team is behaving exactly the way he described in his opener. My MO is only worried about my "cancer numbers" and takes no responsibility for addressing the common adverse effects of ADT. Similarly, my personal physician--who is very responsive--only addresses the complaints I bring to her; e.g., "my blood pressure sure is getting high" = OK, here's blood pressure medicine. I know we each need to become informed advocates for ourselves, but shouldn't somebody putting me on ADT for the rest of my life at least discuss the cardiovascular and metabolic changes I'm heading for, and offer steps to address those? This video made me lose confidence in my team, and I'm very shaken by that.
An additional thought about this video and orchiectomy: As some of you may recall, I previously posted about pros and cons of orchiectomy, and based in part on your comments, I'm "on the wait list" for the surgery. Did you see Klotz' quick comment (at about 10:40) about 'bad effects' of orchiectomy compared to antagonists? Is this cause to rethink orch.?
