So, along with monitoring, I know a lot of patients,
you know obviously, everybody wants to avoid a recurrence,
so they're wondering, "Is there any nutritional or lifestyle changes that they can make to
avoid a recurrence, or is it overall health is going to be helpful for them in a big picture?"
Yeah, I mean, good health practices—Dr. Moyad likes to talk about heart-healthy diets
and we all, I think, at this point know what those are—they do translate into lower recurrence rates.
Medications like statins, metformin—which is a diabetes medicine—baby aspirin, these seem to also
translate into lower occurrences. So, the—at least with radiation; they may not have as big an impact
after surgery. Proper dietary practices not only can reduce the risk of future cancer recurrences,
but of course, they reduce a more common cause of death in prostate cancer patients,
which is heart disease. Sadly, you know, it's very difficult for many of us to you know rein
our diets in and and exercise the way we need to, but it does make a big difference, and if people
are able to— if they do have the self-discipline they should implement it; it does matter.
In that sense, have you actually seen diet changes lower PSA?
I've seen diet changes stop rising PSAs from rising. It's
fairly easy to monitor people after surgery and if they have a relapse, historically,
you could see you could plot it out on a graph and I've seen patients implement stringent vegetarian
diets and have their PSA stop rising and control their PSA rises with diet alone.
And how do you think exercise affects treatments? I mean
it would make sense that somebody who has a much stronger body and has muscle
be able to maintain and handle the treatments a lot better, right?
Yeah, and testosterone helps men build muscle and the removal of testosterone causes muscle atrophy,
which is a much bigger deal than people realize. It makes men feel tired, depressed,
and that can be reversed with fitness training, particularly weight training.
You mentioned Metformin, which I think is really fascinating. Can you
kind of share how Metformin works in prostate cancer because I think a lot of people hear it
and they recognize it in diabetes, but they're not really sure the effects in prostate.
Well, I'm not sure anyone really knows how it works. It was discovered in large
database studies, you know, insurance computers looking at survival of men with prostate cancer
who happen to be taking Metformin, and for some reason, their survival times were longer.
There have been clinical trials, now, giving metformin or placebo to people with prostate
cancer and showing improved survival. It's effective possibly because of its metabolic
effects. You think of metformin and statins are kind of like a good diet in a bottle, and
so if you extrapolate from the fact that good diets matter; if you can achieve some
of those same ends with these medications, you can achieve some of the same results.
So what criteria would you have for a patient who
you're thinking of putting on Metformin? What does that look like?
Well it can help people lose weight, so if someone's overweight,
whether they have prostate cancer or not, you could consider taking Metformin. Patients for
their anti-cancer effect would be the ones that have a type of prostate cancer that's serious
enough to warrant treatment. There are a lot of harmless variants of prostate cancer; we don't,
you know, beat up on them telling them to get on the right diet or take medications
because their particular type of cancer is a paper tiger—doesn't really represent a
threat to them— but for those that have more serious the high-risk prostate cancers or
relapsed (or recurrent) cancers, makes sense for people to consider these medicines.
And what type of side effects would Metformin have?
Usually none; it can cause a little queasy tummy in some patients, but it's well tolerated.
Is this, like, widespread amongst the oncology community? Is this something that you've been
using? I know Dr. Moyad has talked about it, but is this something an average prostate oncologist,
or I guess prostate oncologists are actually quite rare, but medical oncologists would know?
I don't really know. I don't know if the same usefulness is noted in other cancer types.
For general oncologists, they're treating over 100 different cancers. I would guess that it's not
widely understood. It's hard enough just to keep up with the basics of prostate cancer, let alone
these types of refinements.
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