One of the more worrisome and medically significant side effects of ADT is metabolic syndrome. Metabolic syndrome is a suite of features that includes elevated blood pressure, elevated triglycerides, an increase in fasting blood sugar, and an elevated BMI characterized by an increase in fat carried around the waist. The features that define metabolic syndrome are markers for increased risk of diabetes and cardiovascular disease.
When we talk about managing the medically serious side effects of ADT, we often focus on avoiding or controlling metabolic syndrome. In this new paper, the researchers come at this topic from a slightly different direction and ask, How effective are the drugs used to treat metabolic syndrome in slowing prostate cancer disease progression? “Progression,” here, signifies a transition from a “castrate-sensitive” state, where ADT can control the disease, to a “castrate-resistant” state, where the cancer can grow even without testosterone.
Various drugs, such as the statins that are used to control cholesterol, and metformin, which is used to control diabetes, can help men on ADT live longer by reducing their risk of a heart attack or diabetic crisis (i.e., by controlling metabolic syndrome). But can they slow the progression of the prostate cancer itself?
This new study, involving 409 men on ADT, came to a firm conclusion that statins can significantly slow the progression of prostate cancer to the castrate-resistant state. Whereas the authors found that statins are protective against castrate-resistant prostate cancer, they noted that metformin may not confer the same protective effects. They acknowledged though that their sample size of men on both ADT and metformin was too small to confirm that.
This is yet one more study endorsing the use of statins for patients who are planning to go on ADT or who are already on it. What’s new about this paper is that it shows that statins not only help to protect against the cardiovascular risks of high cholesterol, but they can also help slow progression of the prostate cancer itself.
To read the study abstract, see: https://pubmed.ncbi.nlm.nih.gov/35075214/
Reference: Geng JH, Plym A, Penney KL, Pomerantz M, Mucci LA, Kibel AS. Metabolic syndrome and its pharmacologic treatment are associated with the time to castration-resistant prostate cancer. Prostate Cancer Prostatic Dis. 2022 Jan 24. doi: 10.1038/s41391-022-00494-w. Epub ahead of print. PMID: 35075214.