... what, then, do we die of?

[pca2004]

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....

[4] google.com/search?q=is+the+...

[5] google.com/search?q=is+insu...

[cujoe]

Good Post, Patrick,

Your comment "How many PCa doctors pay attention to CVD risk factors?" pretty much sums up one of the major issues for SOC, as with its suppression of T, men's metabolic functions are thrown into disarray. All one has to do is read PCa patient forums to see what a universal issue it is.

Are docs providing outreach assistance to patients to help offset some of those negative impacts to their metabolism? Not that I know of. In fact, patients get more help in that area from patient support organizations and forums than they ever get from the medical services community. (Otherwise, all PCa patients would be evaluated for metformin and statins before starting and while on ADT - and urologists and MOs would be willingly prescribing them.)

As for the importance of lipids, I owe my recognition of the significance of triglycerides to your PM comments several years back pointing me to the Triglyceride/HDL ratio (<2) as being the number to watch. Your consistent focus of insulin resistance as THE major issue to general health is overlooked by all PCa docs IMO. Staying well out of range of IR will prevent most all metabolic-related health issues, whether you have PCa or not.

Thanks, as always, for the invaluable information and insights you provide.

Stay S&W,

Ciao, Kaptin K9

[JohnInTheMiddle]

And I just started on Metformin! 😃 And have been pushing increasing amounts of exercise. My Target in Fitbit language is 650 Zone Minutes a week. I've hit it a few times.

Oh, and I stayed on Degarelix ADT instead of switching to the supposedly more "convenient" Lupron. (See my comments elsewhere.)

Super thanks for sharing!

[addicted2cycling in reply to JohnInTheMiddle]

I've been on Metformin 1,700mg/day since 2015. My original PCP/Friend just had me switch to Berberine Phytosome. First blood work since switch is tomorrow and will see if any change.

[cujoe in reply to addicted2cycling]

a2c - You may be able to provide a n=1 head-to-head of berberine vs metformin - so would be interested in knowing your lab results. (Do you fast before and what time of day is blood draw?) I've never gotten a metformin script, so have used berberine for years - but my fasted glucose remains much higher than I would like @ 90-110. (Target would be a consistent fasted =< 85.)

I am about to start monitoring glucose action using a finger-prick monitor. From those that have monitored, esp. using a CGM, their response to specific foods seems to vary significantly from person to person. That seems to just confirm that dietary advice is very specific to the individual and generalizations are just that, general in nature.

Thanks in advance for any follow-up you provide.

Stay S&W,

cujoe

[pca2004 in reply to cujoe]

Cujoe, etc.

Do you remember when a Life Extension article said that virtually all U.S. adults should be on Metformin? (I suppose that's easier than changing the U.S. food pyramid.)

Well, most doctors refused to prescribe it to those who were persuaded by the article.

So LEF went in search of another AMPK activator. They settled on Actiponin:

pubmed.ncbi.nlm.nih.gov/238...

The LEF product is: AMPK Metabolic Activator:

lifeextension.com/vitamins-...

Background:

lifeextension.com/magazine/...

I suppose one might simply use Gynostemma pentaphyllum, the TCM herb:

"Actiponin® is an ethanol extract of Gynostemma pentaphyllum, a five-leafed perennial that has been widely used as an herbal tea in Korea, China, and Japan for over five hundred years. Traditionally, G. pentaphyllum is used to regulate blood pressure, lower cholesterol, modulate inflammation, improve endurance, and increase longevity."

-Patrick

[addicted2cycling in reply to cujoe]

Fasted for bloodwork as usual. ALSO anxiously awaiting numbers and will indeed post.

Former PCP was an independent Family Practice provider who shut down her office and became a Concierge Dr. to provide the attention to her patients that she could not do with office. She is out of her house now and spends 2 hours or more with each visit and considers the whole body when diagnosing.

[JohnInTheMiddle]

Okay very interested in the berberine. I will watch for your comments on any experience. I understand that berberine and Metformin have some complimentary overlap - is there any issue of too much synergy? Also can you share approximate costs per month?