It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Cancer: Prostate Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 03-23-2011, 10:26 AM   #1
Senior Veteran
(male)
 
Join Date: Nov 2007
Location: Annandale, VA, USA
Posts: 1,730
Blog Entries: 3
IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
Cholesterol and prostate cancer (IMPaCT Conference)

One of the highlights for me at the IMPaCT conference, which I reviewed briefly in a recent thread ("IMPaCT conference just held", initiated 3/14/2011) was the research sponsored by the program on cholesterol's impact on prostate cancer. I've been interested in this topic for years, as earlier research had been suggesting an unfavorable connection, and as statin drugs to control cholesterol had a well-documented effect in lowering the death rate from prostate cancer.

It took me a while to get on a statin, due to unrealistic and out-of-proportion concerns about side effects (yup, the emotional-button-pushing media reports suckered me there), but I've now been on simvastatin (generic zocor) since 5/22/07, nearly four years ago. I regret that I did not start sooner, but at least I'm now past the three year point where substantially greater death-avoidance benefit has been demonstrated for statin use. My level of harmful cholesterol (LDL) is also much lower.

While cholesterol was addressed a number of times at the conference, the main presentation, "Cholesterol and Prostate Cancer" was by Dr. Michael Freeman of Boston Children's Hospital and the Harvard Medical School. He was part of Thursday morning's plenary session, which means that nothing else was going on as the session was designed for attendance by all conference participants. Such presentation placement is noteworthy as it is a sign that the conference organizers considered this topic to be especially important.

Dr. Freeman stated that it is now thought that cholesterol helps cause prostate cancer. He noted there was now abundant evidence that statin use, especially five years use, decreases death from PC. He pointed out that major prostate cancer-causing ("oncogenic) pathways are sensitive to cholesterol, including the P-EGFR, EGFR and two other pathways. He stated that there is a dramatic effect of elevated circulating cholesterol on prostate cancer in animals even after they have been castrated, a form of hormonal therapy. We now know that prostate cancer cells can make their own androgens (testosterone, DHT), a process known as "intratumoral production" (meaning production within the tumor) under certain conditions, which has been a problem for therapy, especially hormonal therapy, and Dr. Freeman identified cholesterol as a potential source for the components of those androgens. He highlighted the fact that high circulating cholesterol is associated with elevated levels of testosterone and DHT, adding that normal prostate cells sense changes in levels of circulating cholesterol and that cholesterol producing pathways are elevated for prostate cancer patients.

In addition to his focus on statin drugs, Dr. Freeman also mentioned the FDA approved drug Zetia® (ezetimibe). Zetia®, which helps block absorption of cholesterol and acts via the intestine rather than the liver where statins act, can enhance cholesterol lowering in addition to a statin drug. Zetia® also helps decrease growth of new blood vessels (anti-angiogenesis), which tumors need to grow. Surprisingly to me, it was as good as finasteride in reversing benign prostate enlargement in hamsters. He added that Zetia® "induces regression without altering the epithelium"; frankly, I have a clue what that means but need to think further about it. As always with drugs, there is some risk, but it struck me as modest when I read about the drug. (I am now fairly savvy about the disease but have had no enrolled medical education.)

My own cholesterol levels are now considered fine, even exceptional, but his talk is leading me to think I might want to get that LDL cholesterol level even lower. I'll be watching closely for further research on cholesterol and prostate cancer. (My fasting lipid results last September, after stopping hormonal therapy the previous April, were: total cholesterol 174, HDL 84 , LDL 78, Trigs 60. Thanks to the statin and my diet, my results while in the middle of my third hormonal blockade cycle were still good: July of 2009 - total fasting cholesterol 198, HDL 87 , LDL 101, Trigs 49).

I plan to add comments about cholesterol to this thread from other IMPaCT presentations and posters in the future.

Take care all,

Jim

Last edited by IADT3since2000; 03-23-2011 at 10:31 AM. Reason: Added cite for IMPaCT conference thread.

 
The Following User Says Thank You to IADT3since2000 For This Useful Post:
Tim E (03-31-2011)
Sponsors Lightbulb
   
Old 03-24-2011, 10:35 AM   #2
Senior Veteran
(male)
 
Join Date: Nov 2007
Location: Annandale, VA, USA
Posts: 1,730
Blog Entries: 3
IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
Re: Cholesterol and prostate cancer (IMPaCT Conference)

I've just added a new thread on recent research reporting an awesome impact of the statin class of drugs in improving radiation for higher risk patients. Dr. Freeman did not mention this in his talk - the focus of the first post in this thread, and I considered it to be stand-out news that should not be buried as a detail in this thread.

I also wanted to add a significant detail about Dr. Freeman: his research on cholesterol and prostate cancer was substantially supported by the DoD's Prostate Cancer Research Program.

What an encouraging pair of new developments on statins!

 
Old 04-12-2011, 10:16 AM   #3
Inactive
(male)
 
Join Date: Aug 2010
Posts: 689
Tall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB User
Re: Cholesterol and prostate cancer (IMPaCT Conference)

I just read some research that throws a curve ball to the cholesterol hypothesis. It's quite annoying that just when we think we're onto something good, some research comes along that challenges what we think we know. But that's what science and keeping an open mind are all about.

In a retrospective case-controlled study, researchers in Taiwan found that:
  1. men who took statins were more likely to have prostate cancer, an average 55% increase in risk
  2. the more statins they took, the greater the incidence of prostate cancer. Risk increased from +17% among those with the lowest cumulative intake to +86% among those with the highest cumulative intake.

Since this is a retrospective study, it does not mean the association is causal. It may mean, for example, that men who have genes for high cholesterol, and therefore take more statins, are more likely to develop prostate cancer, which is unaffected by statin use. The researchers also did not stratify the sample by the aggressiveness of the PC. It may hold true that it helps for aggressive PC, but that doesn't show up because the incidence is relatively small. Possibly, there is a racial component as well.

Here's the abstract of the study:
http://www.ncbi.nlm.nih.gov/pubmed/21480313

- Allen

 
Old 04-12-2011, 01:14 PM   #4
Senior Veteran
(male)
 
Join Date: Nov 2007
Location: Annandale, VA, USA
Posts: 1,730
Blog Entries: 3
IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
Re: Cholesterol and prostate cancer (IMPaCT Conference)

Hi Allen,

I'm responding to your post #3, which provides recent evidence from a study that runs counter to the concept that statins are good for prostate cancer patients. Briefly, the study indicated:


[QUOTE]
Quote:
Originally Posted by Tall Allen View Post
...In a retrospective case-controlled study, researchers in Taiwan found that:
  1. men who took statins were more likely to have prostate cancer, an average 55% increase in risk
  2. the more statins they took, the greater the incidence of prostate cancer. Risk increased from +17% among those with the lowest cumulative intake to +86% among those with the highest cumulative intake.
You also added this comment:

Quote:
Since this is a retrospective study, it does not mean the association is causal. It may mean, for example, that men who have genes for high cholesterol, and therefore take more statins, are more likely to develop prostate cancer, which is unaffected by statin use. The researchers also did not stratify the sample by the aggressiveness of the PC. It may hold true that it helps for aggressive PC, but that doesn't show up because the incidence is relatively small. Possibly, there is a racial component as well.

Here's the abstract of the study:
http://www.ncbi.nlm.nih.gov/pubmed/21480313

- Allen
I have three thoughts. First, also in line with your thought about association rather than cause, it is also possible that lifestyle, especially diet, leads to both problems encouraging statin use and prostate cancer. Second, the "confidence intervals" for some of the results are rather large; as this means the true value is highly likely to fall somewhere in that large range, it could fall very near the no impact line. The third thought is that the results are due to chance, such as caused by an accidental grouping of a medium sized group of statin users many of whom happened to have prostate cancer.

It's also possible, unfortunately, that this study has it right and that many other studies have it wrong. My strong hunch is that that is not so, but I don't know how we can be certain. At the conference, the doctor presenting the talk mentioned a number of researchers who were all coming to the same conclusion that cholesterol helps cause prostate cancer. Many of them have also published encouraging results for statin use and prostate cancer, especially aggressive prostate cancer. Here is the list, except for one author whose name I evidently scrawled wrong, and the PubMed searches I just ran (www.pubmed.gov). I've added Dr. Moyad's hits as his name came up a lot.

"prostate cancer AND statin AND platz ea [au]" 15 hits
"prostate cancer AND statin AND moyad m[au]" 11 hits
"prostate cancer AND statin AND mondul [au]" 4 hits,
including three links to free copies of the entire study
"prostate cancer AND statin AND banez [au]" 1 hits
"prostate cancer AND statin AND gutt r [au]" 1hits

Some of these overlap. Overall, I got 172 hits for " prostate cancer AND statin ", including 54 with links to free copies of complete studies.

I don't have the time at the moment to look into these, but perhaps someone else does. Some of the studies are similar in form but not result to the recent study from Taiwan.

As you were thinking, it would be nice to have completely consistent results, but that seems to rarely be the case for prostate cancer.

Take care,

Jim

 
Old 04-12-2011, 02:37 PM   #5
Inactive
(male)
 
Join Date: Aug 2010
Posts: 689
Tall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB UserTall Allen HB User
Re: Cholesterol and prostate cancer (IMPaCT Conference)

Unfortunately, all of the research so far have been retrospective cohort studies and subject to the same kinds of errors. Those studies are relatively cheap and easy to do, but never really address causation, just association.

I noticed that there is a prospective controlled clinical trial on the effect of statins for prostate cancer for 4 weeks prior to RP, and another one (only in Phase II) looking at statins + a COX-2 inhibitor as a treatment for rising PSA after local therapy. They're both small, single-center studies, but it's better than the merely suggestive analyses that seem to be all that is available now. Hopefully, they will demonstrate a causative effect.

http://clinicaltrials.gov/ct2/show/NCT00572468
http://clinicaltrials.gov/ct2/show/NCT01220973

- Allen

 
Old 04-12-2011, 05:44 PM   #6
Junior Member
(male)
 
Join Date: Jan 2010
Posts: 20
Mitch128 HB User
Re: Cholesterol and prostate cancer (IMPaCT Conference)

Quote:
Originally Posted by IADT3since2000 View Post
It took me a while to get on a statin, due to unrealistic and out-of-proportion concerns about side effects (yup, the emotional-button-pushing media reports suckered me there), but I've now been on simvastatin (generic zocor) since 5/22/07, nearly four years ago. Jim
Jim,

Based on your research and personal experience taking this (CoQ10) dietary supplement, do you feel it has improved the delivery of simvastatin to your system?

Thanks,

Mitch in SC

< edited >

Last edited by hb-mod; 04-13-2011 at 01:15 AM. Reason: Please do not copy and paste from another website, or post unapproved websites. Thanks!

 
Old 04-13-2011, 05:46 AM   #7
Senior Veteran
(male)
 
Join Date: Nov 2007
Location: Annandale, VA, USA
Posts: 1,730
Blog Entries: 3
IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
Re: Cholesterol and prostate cancer (IMPaCT Conference)

Hi Mitch,

I'm responding to your post #6 about CoQ10 and statins, in green. You wrote in part:


Quote:
Originally Posted by Mitch128 View Post
Jim,

Based on your research and personal experience taking this (CoQ10) dietary supplement, do you feel it has improved the delivery of simvastatin to your system?

Thanks,

Mitch in SC

< edited >
I don't recall anything about improvement in delivery. I take the CoQ10 because statins have been shown to interfere with the role of Coenzyme Q10. Dr. Charles "Snuffy" Myers, MD, now known for his work in prostate cancer but previously the lead pharmacologist at the National Institutes of Health, was involved very early in this area. He recommends a small amount of CoQ10, such as 30mg to 50mg, to restock CoQ10 when on a statin, noting that this helps counter a slight shortness of breath that some of us experience, and other effects of a shortage of CoQ10.

I take either 30 mg or 50 mg, but sometimes 100 mg, depending on the lowest dose on the shelf at the drugstore. I was experiencing an unexpected occasional and slight shortness of breath after I started simvastatin four years ago, and when I finally started taking CoQ10 daily, my impression was that the shortness of breath pretty much disappeared. PubMed, www.pubmed.gov, which we can use on this board because it is Government sponsored (NIH), gives us access to many abstracts of research papers and some complete papers. Just search for " coq10 AND statins ".

Take care,

Jim

 
Old 04-14-2011, 11:23 AM   #8
Junior Member
(male)
 
Join Date: Jan 2010
Posts: 20
Mitch128 HB User
Re: Cholesterol and prostate cancer (IMPaCT Conference)

<<I don't recall anything about improvement in delivery>>

Jim,

The jist of what I've read about statins is they have been found to decrease CoQ10 production as a side effect of their otherwise salubrious action. Did you clear this with your Doc or otherwise research this to your satisfaction before taking?

Thanks,

Mitch

Last edited by moderator2; 04-14-2011 at 11:26 AM.

 
Old 04-14-2011, 05:48 PM   #9
Senior Veteran
(male)
 
Join Date: Nov 2007
Location: Annandale, VA, USA
Posts: 1,730
Blog Entries: 3
IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
Re: Cholesterol and prostate cancer (IMPaCT Conference)

Hi Mitch,

I'm responding to your immediately preceding post.


Quote:
Originally Posted by Mitch128 View Post
.... Did you clear this with your Doc or otherwise research this to your satisfaction before taking?

Thanks,

Mitch
Yes, I actually talked to both my oncologist and my internal medicine doctor about it.

Take care,

Jim

 
Old 04-16-2011, 03:25 PM   #10
Senior Veteran
(male)
 
Join Date: Nov 2007
Location: Annandale, VA, USA
Posts: 1,730
Blog Entries: 3
IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
Re: Cholesterol and prostate cancer (IMPaCT Conference)

CONCERN ABOUT ZETIA® (EZETIMIBE) FOR FURTHER LOWERING CHOLESTEROL

In the initial post on this thread, I noted what I had learned about Zetia (ezetimibe), but I have just learned about a concern we should have in using this drug. Here is what I wrote:


Quote:
Originally Posted by IADT3since2000 View Post
...
In addition to his focus on statin drugs, Dr. Freeman also mentioned the FDA approved drug Zetia® (ezetimibe). Zetia®, which helps block absorption of cholesterol and acts via the intestine rather than the liver where statins act, can enhance cholesterol lowering in addition to a statin drug. Zetia® also helps decrease growth of new blood vessels (anti-angiogenesis), which tumors need to grow. Surprisingly to me, it was as good as finasteride in reversing benign prostate enlargement in hamsters. He added that Zetia® "induces regression without altering the epithelium"; frankly, I have a clue what that means but need to think further about it. As always with drugs, there is some risk, but it struck me as modest when I read about the drug. (I am now fairly savvy about the disease but have had no enrolled medical education.)
Dr. Charles "Snuffy" Myers, a leading medical oncologist who specializes in prostate cancer and a leading National Institutes of Health pharmacologist earlier in his career, spoke at a nearby support group today. I asked him what he thought of Zetia for further lowering cholesterol beyond what you could achieve with a statin. He replied that the drug did succeed in so lowering cholesterol and for a while had quite a following among doctors, but that when researchers looked at some clinical trial results, the drug appeared to have some unfavorable effects. One abstract I just looked at stated that there was a sharp reduction in use of ezetimibe in 2008 and 2009.

I went to www.pubmed.gov, a site we can use on this board because it is Government sponsored (US NIH), and tried to find out why. I used this search string " ezetimibe AND survival ", getting 103 hits, and then added these "Limits": only items with abstracts, Humans, Clinical Trial. That cut down the list to just 12.

All the twelve studies were favorable except for one, but that one was impressive. It reported results in the large SEAS study (Simvastatin and Exetimibe in Aortic Stenosis patients), which was a randomized, double-blind trial involving 1873 patients with mild-to-moderate, asymptomatic aortic stenosis. The patients received either 40 mg of simvastatin plus 10 mg of ezetimibe or placebo daily. Here is the conclusion section of the abstract.
"CONCLUSIONS: Simvastatin and ezetimibe did not reduce the composite outcome of combined aortic-valve events and ischemic events in patients with aortic stenosis. Such therapy reduced the incidence of ischemic cardiovascular events but not events related to aortic-valve stenosis. (ClinicalTrials.gov number, NCT00092677.)"Well, that's not a home run but doesn't look so bad. However, the results section included this line: "... Cancer occurred more frequently in the simvastatin-ezetimibe group (105 vs. 70, P=0.01)." Whoops , that gets one's attention! The study was published in September 2008 in the prestigious New England Journal of Medicine. There were a lot of follow-up comments. I'm thinking this is the study that soured the medical community on the drug, but I'm not sure. Maybe there was another study outside the range of my search. I thought Dr. Myers mentioned an adverse effect on survival, but I may have misheard. Any help with this?

Thinking about that 105 (simvastatin plus ezetimibe) vs 70 (just simvastatin) difference in cancer, we need to remember that a lot of people in this group are going to come down with cancer over four years or so of such a study whether they take any drug or not. But why is there such a difference, with the "p" value of 0.01 indicating a very small likelihood that the result is due to chance and not a true consequence of taking the combination instead of just the single drug? Assuming the patients in the trial were evenly split, then about 936 were taking the combination, and 105, or 11.2% developed cancer. If we assume that the simvastatin only group was a true placebo, then, subtracting 70 from 105, only 35 patients, or 35/936 = 3.7% of the cancer was presumably due to the drug combination. That's not a lot, but it is a concern. I'm thinking it was enough to cause the sharp reduction in use of ezetimibe, especially if adding ezetimibe was not a therapeutic home run with these patients.

On the other hand, cholesterol is a significant player in prostate cancer but not in other cancers. It seems to me it may still be a good bet to use ezetimibe to further reduce cholesterol and help us fight prostate cancer, but the jury is still out. I'm hoping that the leading doctors will look at the newly emerging research on cholesterol and prostate cancer and take another look at ezetimibe.

In the meantime, Dr. Myers suggested that both pistachio nuts and avocados have the same agent, beta sitosterol, that ezetimibe does, and that those foods - both with healty fats, may help us further reduce cholesterol. I bought a couple of avocados on the way home and served myself a healthy portion of pistachios at lunch.

Take care,

Jim

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
Prostate and Supplements Helopilot52 Cancer: Prostate 10 04-04-2011 05:46 PM
PSA Causes Prostate Cancer Tall Allen Cancer: Prostate 3 03-20-2011 04:21 PM
Promegranate Juice May Slow Prostate Cancer According to UCLA Study builder Cancer: Prostate 19 03-17-2011 06:07 PM
Active Surveillance for Prostate Cancer: Age of the Patient IADT3since2000 Cancer: Prostate 22 09-23-2010 06:01 PM
Brachytherapy impact on prostate Forevercured Cancer: Prostate 23 07-18-2010 02:22 PM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added




Top 10 Drugs Discussed on this Board.
(Go to DrugTalk.com for complete list)
Casodex
Cialis
Cipro
Flomax
Levaquin
  Levitra
Morphine
Proscar
Tylenol
Viagra




TOP THANKED CONTRIBUTORS



Tall Allen (174), IADT3since2000 (148), Baptista (97), Gleason9 (28), harpman (27), Johnt1 (22), honda50 (9), tumbleweed (6), flyfisher37 (6), bharlan (5)

Site Wide Totals

teteri66 (1180), MSJayhawk (1005), Apollo123 (905), Titchou (848), janewhite1 (823), Gabriel (759), ladybud (754), midwest1 (669), sammy64 (668), BlueSkies14 (607)



All times are GMT -7. The time now is 09:40 AM.



Site owned and operated by HealthBoards.com™
Terms of Use © 1998-2014 HealthBoards.com™ All rights reserved.
Do not copy or redistribute in any form!