New study of SEER data below [1].
The old comforting words that men with PCa "die with the disease, not of it" does not apply once mets occur, of course, but is largely true for local disease (the majority of cases in the U.S., due to screening practices.)
It has long been known that men with PCa are at an increased risk for cardiovascular disease. Mark Moyad's view that "Heart healthy is prostate healthy", ("and heart unhealthy is prostate unhealthy.") [2] is largely true imo.
The new study gives a clearer view of cardiovascular mortality in local PCa.
"... cumulative CVD-related death ... surpassed PCa almost as soon as PCa was diagnosed in the low- and intermediate-risk groups."
"... in the high-risk group, CVD surpassed PCa approximately 90 months later" {Is that because there is a 7.5 year washout period as "high-risk" becomes "metastatic" for some?}
Overall, "... cumulative CVD mortality increases steadily with survival time and exceeds PCa in all three stratifications (low, intermediate, and high risk)."
"Patients with localized PCa have a higher CVD-related death than the general population.
"Management of patients with localized PCa requires attention to both the primary cancer and CVD." How many PCa doctors pay attention to CVD risk factors?
According to the CDC [3]: "Leading risk factors for heart disease and stroke are high blood pressure, high low-density lipoprotein (LDL) cholesterol, diabetes, smoking and secondhand smoke exposure, obesity, unhealthy diet, and physical inactivity."
What about the Metabolic Syndrome? According to the Mayo [4]: "Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels."
But what about insulin resistance? According to the National Institutes of Health [5]: "The clinical expression of insulin resistance (the metabolic syndrome or any of its components including obesity, hyperinsulinemia, hypertension, and dyslipemia) has been related to cardiovascular disease as well."
My PCa focus has been on triglycerides (the biological fate of excess dietary carbohydrate), and insulin resistance. Both have been associated with PCa.
If pre-diabetes turns into diabetes, the insulin resistance problem has been solved (overworked pancreatic beta cells have shut down and the pancreas is unable to cope with glucose spikes.) When this occurs, a diabetic man will have a lower risk for PCa (after about 12 months.) PCa is the only cancer where a diabetic has a reduced risk. For almost all other cancer types, the diabetic has increased risk.
At the risk of being reductive, I think that PCa doctors should target insulin resistance - via Metformin. {Metformin is the primary drug for new diabetics. Apart from dietary advice, Metformin is initially used as monotherapy. IMO, this would also be a good starting point for pre-diabetics.}
{The surrogate for insulin resistance is the triglycerides:HDL-cholesterol ratio. 1:1 is great; 3:1 is dreadful. imo}
For those unfortunate to have metastatic disease treated with ADT, Metformin is even more important, since ADT increases Metabolic Syndrome risk factors.
But wait a moment, if we successfully reduce CVD & PCa mortality risk - what then will we die of?
-Patrick
[1] pubmed.ncbi.nlm.nih.gov/376...
[2] link.springer.com/article/1....
[3] cdc.gov/chronicdisease/reso....
The Warburg Effect [an increase in the rate of glucose uptake and preferential production of lactate, even in the presence of oxygen.]
