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.
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 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…
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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