The gift of ADT (androgen deprivation) for advanced prostate cancer is a longer life. The harms caused by that same ADT are myriad and have been well discussed here. Included in those range of effects from very low testosterone is a powerful tendency to put on body fat. And to lose muscle mass and strength (sarcopenia).
We can all agree that the best way to combat this is through a dedicated exercise program including generous helpings of endurance exercise at mild to moderate intensities to burn fat and maintain cardiovascular fitness. And regular weight-lifting or equivalent resistance training to maintain muscle strength and mass in all the major muscle groups and core. And this must be enjoined with some type of nutritional balance, some personal diet that provides good complete nutrition while avoiding excesses and harmful patterns. Again, it has been much discussed here. There is no one right approach for it involves many individual factors.
This can be hard to maintain while on ADT but it is necessary and brings substantial rewards in well being and QOL.
However, for very many of us it is not enough to keep excess fat from accumulating. Resulting in overweight, over-fat (Body Mass index above 27), or obesity (BMI >30). This, in turn can lead to Metabolic Syndrome, Pre-Diabetes and Type 2 Diabetes (T2DM). This is a terribly costly and slippery slope that robs health.
I should list the diagnostic criteria for Metabolic Syndrome: It exists when any 3 of the following 5 criteria are present. 1) Abdominal obesity (waist >40 inches in men or BMI>25). 2) High blood pressure over 130 sys / 80 dias, or on BP Med. 3) Elevated fasting glucose 0ver 100. 4) Elevated Triglycerides >150. 5) HDL Cholesterol <40. Metabolic Syndrome also causes increased blood clot risks and is always associated with insulin-resistance.
There has been a fairly recent revolution in the management of T2DM and pre-diabetes. For many decades the first treatment of choice has been Metformin, one of the safest and least expensive medicines in all the world. If that proved insufficient fro DM control there were a variety of other meds to try, then ultimately on to injectable insulin. The entire picture changed with the bioengineering of a new class of medications, especially: Semaglutide. Semaglutide is a GLP-1 receptor agonist. Glucagon-Like-Peptide 1 receptor. It has revolutionized treatment for T2DM. You have seen the ads, it is marketed as Rybelsus in an oral weekly pill form, and as Ozembic in a once weekly injection.
And Semaglutide causes weight loss, fat loss very efficiently and predictably. This has now been confirmed in clinical trials in non-diabetics for obesity or overweight (BMI>27). And it does it with a great safety and side effect profile. That is the wonderful news and why I am now suggesting that it be considered for those with APC on ADT who have become overweight or obese and are on that spectrum leading to Metabolic Syndrome and T2DM.
The mechanisms of action of GPL-1R agonists are to increase insulin secretion; Thus increase sugar metabolism reducing blood glucose; Inhibits Glucagon (the anti-insulin); Decreases Appetite; And also slows gastric emptying. These all add up to a healthier metabolism profile and fat/weight loss.
They randomized 1306 overweight or obese patients to Semaglutide 2.4 mg orally weekly, and 655 to placebo. Assessment at over one year (68 weeks) showed a mean 15% weight loss in the Semaglutide group. Side effects were mild, most commonly mild GI upset or nausea. You can read the details and discuss with your physicians. It could be a game changer, at least for this aspect of our lives and treatments. Paul
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Hmmm. 🤔 good point. What if one gets it prescribed for Metabolic Syndrome or similar?
Thank youPaul, just read your entire post to Jim. He meets none of the criteria for metabolic syndrome but boy, is he weak! His testosterone is down to 6. Into his 5th month on lupron. Zytiga is next🤷♀️ He installs fence with his men every day, as we have a fence company in Pa., but today he came home saying his legs and arms felt weaker. I feel so very sorry and sad that all of you and my wonderful husband have to deal with the awful side effects of Depravation therapy.
I liked the thought & excited something here applies to me personally, so I checked the price on my UnitedHealthcare/Medicare plan. I would pay $35 a month (assuming my doctor would prescribe it) and my plan would pay $918.72/month! This, even though the US National Library of Medicine says it should cost $195 per month! I guess I will renew my commitment to exercise and diet. I can do more, more consistently, so will keep going based on my inspiration from all you guys! No, you do NOT get to know what I just ate after my healthy lentil soup. (Time to remind myself I do not want nor need the same motivator you wonderful people have.) If I cannot make progress, I might consider the above ripoff of my insurance company. (BTWI do not have cancer, but I do have metabolic syndrome.) Hugs around the room, Kate (Paul's sis)
Just to add, I do think too that another potential revolution in the management of T2DM and pre-diabetes may still be to come, in the form of therapeutic keto diets that 1) are specifically designed to that end, and 2) are prescribed by medical professionals, and 3) are fine-tuned to patients' tastes so that they can actually adhere to them.
Because the definitions and approaches of "doing keto" vary so widely, and because many in the medical professions view any popular fad as intrinsically incapable of progressing beyond "fad" into a viable therapy, it may be some time before this approach moves beyond the realm of DIYers and "fringe" providers.
Even where therapeutic keto diets WERE proven clinically successful and were strictly formulated to meet the needs of the target patients, namely in the cases of epileptic children with intense frequency of seizures (over a century ago), most mainstream medical professionals remained entirely unaware of this. If it were not for the Charlie Foundation, the desperate parents depending on these mainstream medical professionals would have no idea where to turn when the anti-seizure meds failed their kids!
I'll be the first to admit that many men (myself included) are loathe to give up some of their favorite foods, let alone their favorite food GROUP, when they are facing a limited number of years left to eat, drink and be merry. I would prefer a daily pill. But it's good to know that dietary avenues are available, too.
So yes, Semaglutide causes weight loss and fat loss very efficiently and predictably. I think it is fair to add that a well-designed and well-managed keto diet can also cause weight loss and fat loss very efficiently and predictably. This has been confirmed by several on this forum. (But fair warning: adherence is difficult for those with addictive tendencies or with emotional/disordered eating habits.)
I lost all ov my considerable excess fat on keto diet. Down to a very lean 140 lbs. that is why o do not personally need semaglutide. Now maintain that with low carbs though not strictly keto. Much flexibility in that and much energy with no weight regain. Agree fully with you on that. However it seemed very easy for me. Not so for some others. Am curious about the MPP and may try it. But confused about the need for bicalutamide bracketing and short bust testosterone.
I am trying to drop all my supplements and none essential medication. I dropped (at least I have a drug holiday) statin, metformin (i really hate this medication), no more aspirin for me, i stopped doxycycline after 6 months, and I am still on:5mg a day perindopril arginine (my high blood pressure medication). It would be nice to stop that too (not good for the bone marrow), but I am too fat and have sleep apnea. I should eat less and walk more. I believe this COVID lockdowns made me lethargic. I have no intention starting any new medication except if it is absolutely necessary. I should lose weight by the easiest way. That is to eat more healthy food and less. I am trying to exercise. I am doing strength training but I want to properly recover from the exercise before I do it again in 4 to 7 days. Yes, I am walking daily and try to sprint. (Just fast running not really sprinting like in olden days).
You describe the damaging side effects of ADT well and with great specificity. Also, with equally great specificity, the antidote to them that cardiovascular exercise, weight training and caloric restriction (and limiting carbohydrates) provide.
Then you add the following:
‘However, for very many of us it is not enough to keep excess fat from accumulating.’
The problem isn’t that ‘very many’ of us do it and it is not enough, it’s that very many of us don’t do it.
The only reason I make this distinction is that if as you say, ‘we can all agree’ that weight training, cardiovascular exercise and caloric/carb restriction is is the best way to combat this (the negative effects of ADT), then it makes little sense to essentially add ‘except it’s often not enough’.
It’s always enough! However, I can appreciate that the ability of semaglutide to induce weight and fat loss can assist the exercise and diet. It’s hard work and substantial excess fat makes it harder. Unfortunately the semaglutide alone won’t do anything else.
I always sincerely hope that people will use drugs the right way-to supplement best habits. But we should also remember that at this point, as a society, we are prone to look for fast and easier answers in this area, dieting being the most absurd example.
We treat diseases with drugs, then treat the side effects of the drugs with more drugs and supplements. The drugs always carry risks of unknown proportion, thus the endless disclaimers in the advertising.
A unfit and weak body with less fat is superior to a fat one no question. For the obese and severely deconditioned I can imagine great possibility for this drug-maybe.
Ah Poo - as I apparently have a high fasting glucose and meet all of the indications of metabolic syndrome, I think I will bring this up with my MO on wednesday...
Thank you Paul, I may be a candidate. Was 217 lbs at Dx in Oct 2020 (21 mos ago). This morning 245= +28 lbs. = +1.3 lbs/mo. It’s cumulative !!My Onco says I am by far his most active Stage 4 patient. 3-5 days x 2-3 hrs of intense Pickleball, walking out 2 Aussies 3-5 x wk, weights 3x wk., Gardening in the Florida Summer. Blessed w a slow metabolism I guess.
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