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Re: A Layman's Perspective on the Use of Metformin in the Treatment of Prostate Cancer
Dr. Myers reversed the direction of my PSA, and for the past six months my PSA has remained low and stable. Based on a recent endorectal MRI, which he prescribed, Dr. Myers estimated that a 1.1 mm tumor detected by choline scan a year or so ago has shrunk by 60 to 70 per cent. He concluded that if the tumor continues to shrink at its current rate he could remove casodex from my protocol, i. e., the only drug he has prescribed for me that has adverse side effects.
It took a fair amount of research on my part before I settled on Dr. Myers as my "recurrent" Pca physician. I am pleased with my progress to date. The current metformin issue is a bit worrisome, but the jury is still out.
In particular I like the following characteristics he possesses:
--He has extensive medical research experience.
--He is a Pca survivor himself; he knows what its like.
--His cutting edge approach to treatment.
--He truly treats the whole person. He strives to ensure that you are as healthy as possible including weight, blood pressure, cholesterol, diet, etc.
--He carefully monitors and manages the health of his patients including the adverse side effects of the medications he has prescribed.
In my (humble) opinion there is room for improvement in the following areas:
--He does not participate in Medicare.
--By Virginia law he must personally see his patients once a year.
--Due to his busy schedule and I suspect his personal inclinations, he does not thoroughly explain his treatment decisions and expectations. His responsiveness on an Internet Patient Portal offsets this factor substantially. I can express a treatment concern at any time and he typically responds in three or four days ( sometimes however rather cryptically).
Regards Don O.
P.S. There are a few metformin issues I would like to kick around with you, but this is not the best forum to do so. If there is any interest on your pat let know. My email address is as follows: donandmar@yahoo.com.
Re: A Layman's Perspective on the Use of Metformin in the Treatment of Prostate Cancer
John and all other interested YANA participants please see below:
Recent email to Mike Scott:
Have you seen or do you have access to the Swiss study which Dr. Myers cited in which metformin proved effective in the treatment of metastatic prostate cancer ? I would be very interested in and appreciative of your evaluation of this document
Mike's reply:
Don:
Have a look at the following report, I think this has to be the Swiss study Snuffy is referring to. I would describe it as "interesting" but far from "compelling". The number of patients is way too small.
The Potential of Metformin in Prostate Cancer
We have previously commented (more than once) on the perception that metformin may have some value in the management of prostate cancer. A recently reported (albeit small), prospective Swiss study, has added to our knowledge in this regard.
Rothermundt et al. wanted to explore the effects of metformin in treatment of patients with castration-resistant prostate cancer (CRPC). In particular, they wanted to investigate impact of this drug on progression-free survival (PFS) and PSA doubling time in men with metastatic CRPC.
They enrolled 44 patients with progressive, metastatic CRPC into a single-arm, Phase II clinical trial during 2011. All 44 patients were treated with metformin (1 g twice daily) until disease progression. (The paper’s abstract does not tell us what other drugs these patients might also have been taking at the time.) The primary endpoint of this study was the absence of any disease progression at 12 weeks after initiation of therapy.
Here is what they found:
•16/44 patients (36 percent) were progression-free at 12 weeks.
•4/44 patients (9 percent) were progression-free at 24 weeks.
•2/44 patients (5 percent) had a PSA decrease of 50 percent from baseline.
•23/44 patients (52 percent) exhibited prolongation of their PSA doubling time.
•There was a significant change in insulin-like growth factor-1 (IGF-1) and IGF binding protein 3 from baseline to week 12.
Now this is a small, single-arm trial and, as the authors have been careful to point out in the conclusion to their original paper, as well as in a separate “Beyond the Abstract” set of comments on the UroToday web site, the clinical effect shown in this trial is “modest” at best. The authors also note that it is far too early to come to the conclusion that metformin is an appropriate form of therapy for most men with prostate cancer, but there are several other clinical trials ongoing, and we shall have to see if this “modest” effect is replicated in some of those other trials.
This is the material I had planned to share with you John and discuss in a less public forum. At this juncture I'm hoping to secure your participation and invite all others to review, make use of the data in any way they can and submit their thoughts and comments.
My thoughts are as follows: The study supports Dr. Myers' use of metformin, but I tend to agree with Mike it is "less than compelling."
Hi Don et a,
Please accept my apology for the no show of late. Sadly we have had a breavement in our family. I should be back on deck again in a few weeks.
best wishes,
john
p.s. the yana database analysis is well underway. It should make for some very lively discussion.
Re: A Layman's Perspective on the Use of Metformin in the Treatment of Prostate Cancer
This discussion began as an affirmation of the use of metformin. I have since learned not everyone is convinced of its value. In response to my journal entry (see the first posting on this thread), Mike Scott,one of my trusted advisors, responded as follows:
"In contrast to Dr. Myers views, however, there was a report just a few months ago based on a meta-analysis of data from nearly 1,000 patients, all of whom had a history of treatment with metformin and all of whom were newly diagnosed with non-metastatic prostate cancer between April 1, 1998 and December 31, 2009, suggesting no benefit whatsoever from their use of metformin before or after diagnosis with prostate cancer.
Indeed,in that study (see here) a cumulative duration of treatment (before and after diagnosis with prostate cancer) with metformin of ≥ 938 days was actually associated with a roughly threefold increase in risk for prostate cancer-specific mortality.
In all honesty, until we have some data from a large, well-conducted, randomized trial, I think the jury is out on whether metformin has any meaningful clinical benefit in the management of prostate cancer."
I sent "Iron Mike's comments to Dr. Myers who weighed in as follows:
"THAT STUDY IS A POPULATION-BASED STUDY AND AS SUCH PROBABLY NOT WORTH THE PAPER IT IS WRITTEN ON. WE HAVE A PHASE 2 TRIAL SHOWNG A RESPONSE RATE CLOSE TO THAT OF TAXOTERE".
For the record: I will continue following Dr. Myers' protocol until I see convincing evidence that it is more harmful than helpful.
