You guys have empowered me to ask the right questions...
I met with my MO today and he agreed to start measuring DHT , Estradiol and free Testosterone as well and PSA and T going forward.
PSA was stable at 0.03 only blood # out of ordinary was ALT = 99 normal range 16-61. Dr. says "liver enzymes were elevated and your potassium levels were low."
We had a discussion about Avodart and he said he would consider a prescription if I could show him persuasive studies.
The following 5 are the best I could find. Does anyone have a favorite study that helped them convince their MD to prescribe Avodart?
Multivariable adjusted HR of 5ARI treatment in predicting progression-free survival
was available in five studies. Our results demonstrated 5ARIs could significantly prolonged
the progression-free survival time in PCa patients (HR = 0.57, 95% CI [0.34–0.96],
P = 0.04), with moderate heterogeneity (I
2 = 69%, P = 0.01) (Fig. 6). The inverted funnel
plot did not find any publication bias.
Dutasteride is known to be effective in preventing prostate cancer and treating low-risk prostate cancer. However, the role of SRD5A inhibitors in the progression of prostate cancer to CRPC has not been well studied (18). The development of CRPC is still dependent on DHT, and some next-generation drugs targeting the androgen signaling pathway were reportedly effective (11-13). We therefore assessed the effects of dutasteride in patients with CRPC by assessing changes in PSA levels. The present study showed that 41% of patients with progressive CRPC showed a decrease in their PSA level, with 17% showing a decrease greater than 50%.
Avodart blocks DHT
In a paper published in June of 2018, a team led by Nima Sharifi from the Cleveland Clinic identified that certain metabolites of abiraterone are AR agonists. As such, abiraterone metabolism creates its own competitor, in a manner of speaking... [by producing] 3-keto-5-beta abira abiraterone [which] ends up as an androgen agonist, thus potentially mitigating the antitumor potency.
The enzyme that catalyzes the conversion of D4 abiraterone to 3-keto-5-alpha abiraterone is 5 alpha reductase, the very enzyme that could be catabolized by the addition of a 5 alpha-reductase inhibitor such as finasteride or dutasteride. Although such treatments have not resulted in substantial antitumor activity, they have not been studied in this context.
One possibility is that we could combine abiraterone with 5 alpha reductase inhibitors. This has been done on a small scale but not based on the genetics of polymorphisms."