Interesting paper - basically showing that statins reduce PCa mortality among high-risk PCa patients, metformin doesn't appear to, but the combination of metformin and a statin results in an even better result than the statin (or metformin) alone.
I keep track of papers on this subject since I've been on this combination since I was diagnosed - 5+ years ago. I'd been on statins forever (hyperlipidemia), but added metformin when the rumor went around (Snuffy Myers I believe) that it did good things for PCa patients. I felt it was a nothing to lose sort of thing since there are pretty much no bad side effects from metformin, except every nurse you meet asks how your diabetes is.. (which to date I don't suffer from.)
So I watch these papers. This one can be summed up with a brief quote from it:
The effect of combination use of metformin and sta-tin was particularly substantial among post-diagnostic users with high-risk PCa (54% reduction in PCa mortality) despite the relatively short follow-up time.
To me - 54% is a BIG number. I've seen even newer studies (this one is from 2020) that reinforce this finding, there is one around that concludes there is some small effect on long-term PCa mortality by metformin alone, and a larger effect using statins alone, but there is a synergetic effect using both - with the reduction in mortality from PCa exceeding the two drugs effects added together. Something about combining them makes things work better.
I haven't seen any studies, but my cardiologist put me on "Repatha" - a self-injection drug for hyperlipidemia about 3 months ago. My PSA has been steady at about 0.22 (+/- 0.02) for the past 2 years (with fairly frequent testing.) To my surprise - the last PSA read I had surprised me with a result of 0.15 - a fairly significant difference, enough difference for me to believe it might be real.
Is that low PSA a result of a synergy of the metformin/atorvastatin/Repatha? Dunno, but my medical oncologist thought it was possible. I guess we'll see with my next blood test if it holds at this new lower number.
I'm just passing this along since there are probably quite a few men here who fall into the high-risk category (I was Gleason-10 according to Epstein), and they may be looking for something safe that might help - thinking outside the standard-of-care regimen. Worth reading this paper and if I stumble across the more recent one (which reinforced this conclusion) I'll post it here.
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Don_1213
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I don’t think Rapatha is a statin. I’m on it too. Also, which statins were used in your study? Some are hydrophilic and some hydrophobic. Huge difference in how they may interact with PCa.
I don't know which statin was in the study, (I don't do or participate in any study, I just reported one I thought of interest) perhaps reading the linked paper might clear that up. I know in other papers I've seen atorvastatin was pointed to as the most effective. I happen to be on that (have been for decades.)
BTW - I know Repatha isn't a statin, it has an action on LDL-C, supposedly greatly reducing it. All my other numbers are good- but I have never had control of LDL, often coming in well over 100.. my next blood test should tell me if Repatha did the trick. And the part that I was thinking about is perhaps there is a link between LDL and PCa.. and reducing LDL may reduce PSA. Maybe Tall-Allen might comment, I'm sure he's much more up on these things than I am.
I suspect that Rapatha alone will resolve your cholesterol problem. Will you then stop taking atorvastatin? I know, that would depend if statins possible help with PCa has something to do with the med itself, or just lowering cholesterol.
Atorvastatin was most effective. There's a lot of discussion of when the statin was started (post or pre-diagnosis) that apparently has a significant impact on effectiveness.
One thing I couldn't find was dosage info. What is the standard dosage of metformin?
Snuffy said in his book that PCa will use LDL cholesterol to covert to DHT, an extremely potent form of testosterone when testosterone production is shut down through ADT, so it is best to keep LDL levels in check. You can read about it in his book which is now dated but still contains good information.
It’s dated, since it was published in 2007, but still some good advice and info and fascinating to see how far ahead of the times he was in his knowledge and therapies.
Jane McLelland is a big COMBINATION person and has touted Metaformin with statin and diparidamole for 5-6 years. I believe those two are at the core of Care Oncology Clinic in London protocol.
I don't know what Jane McLelland suggests - but there was a study of atorvastatin vs other statins - and atorvastatin did better at lower recurrence than other statins.
Just as an aside - I was busy this AM cutting a bunch of 80mg atorvastatin into 40mg pills.
My cardiologist who about 6 months ago prescribed "Repatha" (an injectable designed to treat persistent hyperlipidemia - see below) worked so well that he felt the statin dose could be cut in half. With Repatha - my numbers all dropped - for the first time in 20 years of treatment - to not only within normal ranges - but at the lower end of normal ranges. It is a very effective treatment - a bit pricey but I think worth it (Medicare PartD plans have to be convinced to cover it, and even then the copay is about $175/month.) The reasoning behind reducing the statin dose was not only is it possibly not needed - but that level of dosage may be contributing to neurologic/muscle-cramp issues I'm having with my feet and calves.
"Evolocumab, sold under the brand name Repatha, is a monoclonal antibody that is an immunotherapy medication for the treatment of hyperlipidemia. Evolocumab is a fully human monoclonal antibody that inhibits proprotein convertase subtilisin/kexin type 9. Wikipedia"
As per the Care Oncology Clinic protocol I also take Doxycycline100mg daily for a month then switch to Mebendazole 100mg daily for the following month then back onto Doxycycline etc.
I take 2x Yourgut+ capsules daily, 2x Prostaphane capsules daily, 2x Pomi-T capsules daily, 1x Mirtazapine 30mg tablet nightly and 1x Melatonin 2mg tablet nightly.
Weekly I'm on 1x Alendronic Acid 70mg tablet and 3x Life Extension Senolytic Activator capsules weekly.
My standard of care is currently quarterly Prostap injections, daily 4 tablets Enzalutamide (Xtandi) and 2x daily Eliquis (Apixaban) tablets.
I take Eliquis as before being diagnosed with advanced prostate cancer I had recurring DVTs in my legs. It was only when I got my second DVT that I was given a PSA test.
I had a very nasty Decipher (0.91) and so went the Care Oncology route not long after recurrence, following up with eSRT and ADT + zytiga when my PSA got to 0.1. Five years later, my PSA remains undetectable. I have continued with 1000mg/d Atorvastatin, but had to drop the metformin after it started to make me vomit.... probably took it for about two years.
There is little rigor in the various studies that support/don't support such interventions - but I take a similar view to you i.e. the statins don't seem to harm me, so I've just kept going.
I’m on both, as a patient of Snuffy’s I’ve been on Metformin for the past 9 years, God willing I’ll hit the 10 year mark post stage 4, G9 cancer dx in a couple weeks. Statins I’ve been on for quite some time something like 30 years, metformin started with Snuffy. Does the metformin have anything to do with the fact that I’m still alive? I don’t know but I haven’t changed a thing that Snuffy prescribed around 9 years ago and none of my doctors including my current PCa specialist since Snuffy’s retirement, Dr. Sartor, has told me to stop taking anything. My weight despite a decade of ADT drugs is great (within normal BMI) and my cholesterol levels are great too. So on we go…
Were you diabetic before you started metformin. Want to start for dad. He is borderline diabetic so am wondering if 2000 mg a day like you take would drop his blood sugar levels too much. Did you have any side effects from the metformin ?
Also , dad takes 5 mg rosuvastatin since years and his LdL is around 70. Do you know what levels dr myers said it’s good to keep that level at ? And if one kind of statin is better than the other in regard to prostate cancer ?
Just a FYI, major digestive issues can happen even on low dosage. Be prepared. I was 1,700mg/day but began with 850mg until things calmed down then doubled it.
No not diabetic, Snuffy Myers prescribed it for me. There are videos on YouTube where Snuffy explains the benefits of it, from preventing ADT related metabolic syndrome to blocking a pathway prostate cancer uses. I don’t believe I have any SE’s from it, you could slowly ramp up and see how it goes, Snuffy talks about this in one of his videos.
I take rosuvastatin 5 mg too, my LDL is around 60, your dad’s LDL at 70 is a good number IMO, for both cardiovascular reasons and prostate cancer. You don’t want to go too low on LDL, the body needs some to function properly, just keep it at lower levels, 70 is good.
Tinkudi wrote -- "Thanks. 😊. But do you know if berberine is as effective as metformin in pca ? ... "
I have no knowledge if Berberine is as effective so I did the switch ON MY OWN without my doctor's consent because I place my Quality of Life above the need for Quantity of Life and BTW it has resulted in me feeling better now than before. My choice of PCa Treatment for my Gleason 10 diagnosis in 2015 is a 1st time experiment that was also chosen for Quality and not Quantity and as such it was not and is still a non FDA Approved SOC PCa protocol.
Not sure if my choices were wise but as of now this 74yo Unique Eunuch (castrated in April 2015) with no *T* is doing OK.
You also follow dr myers protocol ? Did you ramp up the metformin slowly or started with 2000 mg. Any side effects ? Do you take the slow release metformin or regular one
I would love to see a clinical trial about it with metastatic patients, this study is retrospective (interventional would be way more reliable as it would be more controlled) but the numbers are good
Interesting! I looked up the side effects and came across an article from the Mayo Clinic indicating it MIGHT cause some problems with people taking abiraterone, and should be discussed with one’s MO before taking it. Wondering if anyone’s MO advised AGAINST taking it and, if so, why?
Mine (Dr. Charles Drake, Columbia MD's, NYC) concurred with taking it when we discussed it. He felt it was beneficial, and since I was a G10, anything that might prevent recurrence was a good thing.
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Benefit of statin and metformin in the treatment of high risk CRPC
