Discussions that mention zometa

Cancer: Prostate board


In "Re: Treatment AFTER surgury", response #16 of 04-22-2008 07:44 AM, alibabba raised an important issue that I thought deserved its own thread. Here is his post and my response.

[QUOTE=alibabba;3540642]Hi Jim,
I am so glad you are back from vacation! I have been following your post for months so when I got some psa bounce I really did want your input. I too have been looking at the pomegranate aspect. I am on crestor so I was wondering if the product had any adverse reactions as grapefruit juice does. I will check with my uro Dr. on my next visit concerning the other meds. I had read some articles on this as well. I had rather do meds than radiation if it will do the trick. Thanks again for responding to my post.
David

Hi David,

It's an odd coincidence that you would ask about the grapefruit angle at this time - whether pomegranate might have the same effect, as I asked that very question to Dr. Charles Myers when he spoke to a nearby support group a year ago, and I'm traveling to hear him again this Saturday.

His answer a year ago was that pomegranate does indeed act through the same mechanism, but that the effect is much milder than with grapefruit juice. :) I followed up with a question about taking capsules that would involve a significantly higher dose than in 8 ounces of juice, and he replied that he believed the effect would not be significant. :)

Personally, I would like to see some firm safety data, and I'm sure he would too. But in the meantime, I've decided to take two of the tablets a day, which is equivalent to 24.6 ounces of the juice, per the container. The pomegranate extract I use is licensed from the UCLA team that did the breakthrough research indicating that 8 ounces of the juice dramatically increased PSA doubling time. The team found that doses higher than 8 ounces were more effective, but they were very concerned that more than 8 ounces of juice would contribute to too much sugar in the diet. :( Of course, the extract tablets are free of sugar. :)

I'm not a physician (in fact no enrolled medical education) and I believe there is some risk here, with the amount of risk not really known, so my personal choice is certainly far from an authoritative endorsement. I'm fairly confident the risk is reasonable based on Dr. Myers' comments. That said, it is worth keeping in mind that he is a physician operating at the leading edge of developments, though he is quite mindful of the need for reasonable evidence of effectiveness and safety. But if your are a physician practicing near the edge of knowledge, you may be taking some risks that you would choose not to take based on later data. During the eight years that I've been following Dr. Myers' thoughts, he has moderated some earlier positions as fresh evidence has become available. For instance, he now advises using 200 IU of vitamin E instead of 400 IU; he now favors using vitamin D3 supplements instead of prescription calcitriol (activated vitamin D3) in many cases; and he is concerned about the small risk of osteonecrosis of the jaw for very frequent, long-term use of the bisphosphonate drug Zometa, which is extraordinarily effective in helping to control and even reverse bone metastases from prostate cancer as well as in maintaining and rebuilding bone density. All of his previous recommendations were supported by reasonable safety information, but later information changed the picture.

By the way, like you I'm also taking a statin drug - simvastatin, at the lowest dose. It has lowered my cholesterol to the target area, which is welcome, but I'm taking it mainly because of the accumulating evidence that it helps prevent lethal prostate cancer, especially when a statin is taken for three years or more. I have taken it for about a year, and I hope that the bioavailable dose is not being significantly hyped by the pomegranate capsules. Of course that also applies to other drugs I am taking.

There are some patients who deliberately consume graperfruit juice in order to boost the bioavailable dosage of the drugs they are taking without increasing cost. To me that is a very risky strategy, but we all have to decide what risks we want to take.

For those of us not familiar with the grapefruit juice issue, the problem is that an element in the juice, CYP3A4, which I think is also known as naringenin, reduces the breakdown of many medications by the liver. (It's a little more complex than that, and if anyone can fill in more details, I would like to see them.) That results in a substantially higher dose than there would be without the CYP3A4. Before the problem was recognized a decade or so ago, the drug seldane was a big selling antihistamine. Unfortunately, some seldane users drank grapefruit juice, resulting in a lethal dose of the drug for a few of them. Some other patients suffered liver injury. :(

In an area related to this thread, Dr. Myers is about to launch a clinical trial of vitamin D3 supplementation's effect in increasing PSA doubling time. If he gets the results he is looking for, we would have evidence for another nutritional tactic, like the consumption of pomegranate juice or extract, for increasing PSA doubling time. I will hear him talk about the upcoming trial on Saturday and will post about what he says.

Jim