Lithium and PCa

[IvorOrr]

My own story: forty years on lithium for manic depression, diagnosed with PCa through elevated PSA, prostatectomy followed by eight years of annual PSA tests below 1 while continuing lithium; discontinued lithium to treat parathyroid, four months later PSA over 500, diagnosis Stage 4 PCa, resumed lithium Lupron, six cycles of docetaxel; episode of edema, PSA below 4, first post-chemo bone scan scheduled for next month. I have a lot of confidence in my oncologist and I am following his advice. He knows I have resumed lithium but we have not had the opportunity to discuss in depth. Not much online about lithium and PCa in combination. I am wondering, does lithium mask the presence of PCa, does it protect against PCa, or is there no real interaction? I would appreciate hearing from anyone who has had an interaction between lithium treatment and prostate cancer.

[Tall_Allen]

Lithium replaces calcium in bone, which I know can be a problem in dental health. IDK if lithiated bone metastases show up on a bone scan - but I think it's a good question you're raising. Let us know what your oncologist thinks.

[IvorOrr in reply to Tall_Allen]

Thanks for the quick reply and especially for reminding me about lithium replacing calcium. I will certainly be looking into the interactions between calcium and lithium in the phases of PCa. Most significant question at this time - should I continue lithium or not? Again, thanks.

[dentaltwin in reply to Tall_Allen]

A quick scan of the literature shows contradictory results--some say lithium is actually protective of bone density, others saying it MAY predispose to osteoporosis. One states that bipolar disorder itself is associated with osteoporosis without proposing a possible mechanism.

I've never heard specifically of any effect of lithium on dental health, which of course doesn't mean it doesn't have an effect. I didn't have many patients over the years taking lithium, except for 2--one of which had to switch off because of impaired renal function, and another who actually was NOT being monitored for renal function(!)

[Tall_Allen in reply to dentaltwin]

My friend was taking lithium for years and lost some jaw bone. His dentist blamed it on the lithium, but I trust you more.

Bone metastases, with active bone overgrowth and calcium replacement may be different - I really don't know, but it wouldn't surprise me. It's a Group 1 element, whereas Ca is group 2, so maybe not. It depends on its propensity to bond with hydroxyapatite.

[dentaltwin in reply to Tall_Allen]

Well, they're both cations, so potentially it can (and lithium is more reactive). But as this year I'm 50 years past my B.S. in chemistry, thinking about the periodic table hurts my head.

[maggiedrum in reply to dentaltwin]

Not a comment about bone chemistry here. I got my Chem BS in 1974, which was also 50 years ago. Two years ago I volunteered to be a tutor for a high school student for his regular chem class (not AP). There has been a lot of very basic advances in understanding atoms and how they are structured leading to how they work in the real world. My head also hurt in relearning the (simple really) periodic table but it really hurt trying to explain isotopes and reactivity, even at the high school level. I have a hard time imagining trying to tutor a college undergrad. I have been able to go back and get a good background on biochem though through hours and hours of study with advanced level texts. That also made my head hurt some is more interesting to me and certainly knowing it helps with understanding PCa and treatments. I was on lithium for a couple of years and didn't find that it helped me with my own bipolar but everyone has dramatically different benefits or not for psychoactive meds.

[dentaltwin in reply to maggiedrum]

That's terrific. For a hot moment I thought of searching out an old copy of Morrison and Boyd (my organic chem textbook), with which I spent many all-nighters, and Lehninger (my biochem textbook). I laid down until the urge passed.

[IvorOrr in reply to maggiedrum]

Many other people have told me that they tried lithium for a brief period and got no benefit. Early in my life I discontinued lithium twice on doctor's advice and crashed both times so I have been motivated to stick with it.

[maggiedrum in reply to IvorOrr]

It's great that you have received benefit from lithium. Just as with every other med that has been found and used for mental health issues, some work for some, have some limited effect for others, and none for yet others. Prozac has helped many. It makes me suicidal. Lithium has been known to be helpful to many. Just not for me.

[IvorOrr in reply to maggiedrum]

Well stated, and I could not agree more. Psychotropic medicines - probability, not as much predictability.

[timotur]

Some papers suggest Lithium may suppress cell proliferation, so it may have been protective. BTW, congrats on making it 40 years on lithium. My mother was bipolar, and she had SE's from lithium after several years, and transitioned to depakote, which really saved her life.

clinicaltrials.gov/ct2/show...

[IvorOrr in reply to timotur]

Thanks. i will follow up about cell proliferation. This is as good a place as any to say there is a mistake in my story: my time off lithium was closer to a year, not four months.