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Metformin effect or just coincidence?

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Posted 5/1/2019 8:56 AM (GMT 0)
For the diabetics, do note that LDL is the most important thing to control and the new 2018 guidelines are for LDL to be below 70 for diabetics. My endo put me on Atorvastatin, which lowered my LDL from about 70-130 to now 35-65
Posted 5/2/2019 12:13 AM (GMT 0)
So I have been thinking of starting Metformin - for the same reason to keep sugar/insulin levels really low to help PC at bay.

Question is will it adversely effect my natural production of insulin if I stop taking them at some point of time.

Are we creating a problem that doesn’t exist now if we do start taking metfomin - like a supplement.
Posted 5/2/2019 4:17 AM (GMT 0)

hogo2000 said...
Grinnell86, i went on metformin 1700 mg/day and atorvastatin in March 10mg. lipids improved and today the psa dropped from .05 to .04. But isn't the metformin just masking the true PSA? It might make a difference for me as I approach SRT. Should I be waiting 10-13 days (the studies show it remains in plasma for up to 13 days) and retest to find out my "true" value, or just accept this as my fully-dosed metformin/statin adjusted psa and go from here. I don't want to be lulled into not acting with SRT.

Have call into Paul Nguyen at Dana Farber. Thoughts?

Hogo,
Some folks think that Metformin helps with the fight against PC, other cancers and a bunch of other issues. I do not know if this has ever been proved, but I wouldn't be surprised if it does.

However, I'm pretty sure it is proven that Metformin improves insulin sensitivity, thus leading to lower blood insulin levels as well as lower blood sugar levels. Insulin resistance(opposite of sensitivity) and higher blood insulin levels are heavily implicated in poorer outcomes for numerous cancers, including 3 to 8 times worse for PC.

So, it is at least reasonably possible that Metformin is not just masking your PSA, but actually improving your PC status, meaning fewer PSA producing PC cells left alive. It is def possible. Any dietary approach that lowers blood sugar/insulin will probably help as much or more than Metformin.

We were told by some authorities that T2 diabetes was actually protective against PC. Which was the ONLY cancer that diabetes was not actually harmful for. So we were told that PC was different from all other cancers, and what helped with them might make PC worse(even though all responded to surgery, RT and often ADT. But I have long called BS on that, and studies showing that greater blood insulin = worse PC ( and all other cancer) outcome back me up. I always said it was not the T2D that was protective, it was the TREATMENT for T2D, which during the early stages lowered blood insulin( i.e. Metformin and improved diet). And this lowering of blood sugar and insulin often started 10-30 years before PC is normally diagnosed. Hence, less insulin to promote growth of PC cells, over decades when the PC might be growing.

Therefore, I would not be overly concerned about your Metformin. If anything, be concerned about the amount of carbohydrates in your diet, which cause you to need Metformin in the first place. Good luck!

Post Edited (BillyBob@388) : 5/1/2019 10:23:10 PM (GMT-6)

Posted 5/2/2019 4:27 AM (GMT 0)

ddyss said...
So I have been thinking of starting Metformin - for the same reason to keep sugar/insulin levels really low to help PC at bay.

Question is will it adversely effect my natural production of insulin if I stop taking them at some point of time.

Are we creating a problem that doesn’t exist now if we do start taking metfomin - like a supplement.


........................................................................................................
I seriously doubt it, but you never know with prescription drugs. What I would expect you to go right back to your pre metformin state unless there has also been a significant change in diet, primarily in the amount of carbs eaten on average. But, I'm just guessing, I have seen no studies on this subject.
Posted 5/2/2019 3:23 PM (GMT 0)
Thanks everyone. Asked my PCP to put me on metformin/lipitor for off-label reasons to slow down PSA increase. Felt helpless seeing PSA increase and not yet time to pull trigger according to two top boston RO's. So...at the very least i am doing something to make my overall health better.

Here is an article, one of many, that talks about metformin/psa decrease. Insulin response absolutely is part of it but some concern about the drop affecting treatment management without proof of improvement in cancer control. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5758272/ Here is another article from about the symbiotic impact of the two drugs. https://www.urotoday.com/conference-highlights/asco-gu-2018/asco-gu-2018-prostate-cancer/101788-asco-gu-2018-individual-and-joint-effect-of-postdiagnostic-metformin-and-statin-use-on-prostate-cancer-mortality-among-patients-with-high-risk-prostate-cancer.html

My RO who i've been consulting with and am lucky enough to have in bullpen if needed said..."just use this number, don't worry about a masking effect. If you want to treat at .08 or .09 instead of .1..." and retest in 3-4 months...I'll take that...along with the lipitor and metformin.https://https://https://
Posted 5/2/2019 4:48 PM (GMT 0)
I have been off metformin since December. I get my blood drawn in 2 weeks. I’ll give an update on all the numbers at that time.

Paul
Posted 5/2/2019 6:50 PM (GMT 0)

Grinnell86 said...
I have been off metformin since December. I get my blood drawn in 2 weeks. I’ll give an update on all the numbers at that time.

Paul

How did you get off Metformin? Diet change?
Posted 5/3/2019 7:46 AM (GMT 0)
A1C went down and I dropped 40 pounds. My GP first dropped my dose to 1000 mg/day for a few months, then had me stop when A1C held steady. He also stopped trilipix, citing studies that it did not do any good. I did have one episode where I experienced low blood sugar, but that was when I was on 1000 mg metformin twice/day. I had golfed that day, which was almost 100 degrees, with just a burrito for breakfast and peanuts on the course.
Posted 5/3/2019 1:30 PM (GMT 0)
G86,
Good for you. Usually, dropping 40 lbs will get er done, looks like it worked again!
Posted 8/13/2019 2:57 AM (GMT 0)
Ok, after 8 months after going off metformin, my PSA nearly doubled from .04 to . 079. Weight has remained steady, so I am convinced that metformin in has a positive effect. I will ask for at least 500mg/ day next Tuesday at my appointment to test my theory. A1C was 5.7. I’ll keep you posted.

Cheers,
Paul
Posted 8/13/2019 11:19 AM (GMT 0)
Wow. I’m glad this thread came up. And yet it begs the question....are there valid studies showing benefit of Metformin for PCa? And if so, why wouldn’t it be approved for PCa rather than being an off label treatment.
Posted 8/13/2019 12:20 PM (GMT 0)
Ken, there have been numerous papers and reports regarding the use of Metformin to help manage PCa. The now retired PCa medical oncologist Dr. Snuffy Myers was among the first to use it and wrote about his experiences with patients nearly a decade ago.

For use for PCa to become on-label requires either a new set of clinical trials specific to the use, which won't happen, or for FDA and Medicare to expand the label use based on the non-trial information available. Of course, any insurance company can choose to reimburse for it in any setting. I haven't checked to see how Medicare treats it for PCa

Often off-label uses become on-label based on use and various reporting methods. Botox for cosmetic uses is a good example. Another is the use of Avastin for wet maccular degeneration. Avastin was originally developed and placed on label for colo-rectal cancer. Then retina specialists found it had value for wet MD and began using it. It then went on-label for such use and spawned new research which has developed several similar drugs for retina problems.

As I remember you are now on Medicare. You should check your Part D insurer and see where it is in their formulary and reimbursement practice.
Posted 8/13/2019 2:06 PM (GMT 0)
I just looked at the Silverscript formulary and metformin (glocophage) is only listed under anti-diabetes. Reimbursement would probably depend on the coding the doctor provides and any appeal that might be made should the reimbursement be denied.
Posted 8/13/2019 3:15 PM (GMT 0)
Do check the GoodRx.com prices for metformin before you expend too much angst on whether insurance/medicare will pay for it. If you shop around the cash price is pennies a day. In my area Walmart sells a 30 day supply (60 tablets, 500mg) for $4.00. Other pharmacies give the stuff away free just to get you enrolled in their system. Be sure you check prices for the generic "metformin" not the brand-name "Glucophage" that costs 100 times as much.
Posted 8/13/2019 5:41 PM (GMT 0)
Here is a ASCO article about lipitor and metformin. https://www.urotoday.com/conference-highlights/asco-gu-2018/asco-gu-2018-prostate-cancer/101788-asco-gu-2018-individual-and-joint-effect-of-postdiagnostic-metformin-and-statin-use-on-prostate-cancer-mortality-among-patients-with-high-risk-prostate-cancer.html

There is also a clinical trial on the use of metformin to radiosensitize PCA cells prior to SRT. I asked my PCP to put me on both just to...do something....I am neither diabetic nor do I have high cholesterol. (in fact it's very low now.... smile

The question I have...is the metformin slowing or killing cells or is it masking the PSA. [
Posted 8/13/2019 7:14 PM (GMT 0)
Thanks Jack, yes i am on Medicare. However, at this point, i aam not coonsidering metformin for PCa, as U'm assuming the SRT +ADT worked (tbd) .
i just find it interesting that many seem to have gotten benefit from it.
I do wonder whether it would be worthwhile to consider as a drug to lower triglycerides. Now THAT would apply to me.
In any case, with metformin an off label drug for anything but diabetes, i wonder if my PCP would even consider prescribing it if i asked. I might, at my next visit
Posted 3/8/2020 2:39 AM (GMT 0)
Yeeha! I am convinced now that metformin is an aid to prostate cancer. Down from .079 to .059 after 6 months back on metformin. I am a believer. I did 500 mg twice/ day being non-diabetic. My new GP is very progressive (and she is also very good looking) and was very open to my suggestions that metformin helps suppress prostate cancer.
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