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Tuesday, January 5, 2016

Metformin and prostate cancer

[Updated June 6, 2017]

A 2014 article in the Journal of the National Cancer Institute by Azvolinksy [PMID: 24511112] [Full Free Text] and a 2014 article by Fleshner in the Canadian Urological Association Journal [PMID: 25243043] [Full Free Text] discuss observational studies on diabetic prostate cancer patients which have shown reduced risk of death from prostate cancer as well as reduced all cause mortality among those taking the widely used inexpensive diabetes drug, metformin. A May 2016 update by Sayyid and Fleshner [PMID: 27195314] [Full Free Text] reviews studies that show a decreased prostate cancer risk with metformin as well as beneficial effects for prostate cancer patients after treatment. Other recent work suggests benefit from combination therapy of metformin with statins [PMC3329836 full free text], [news release], p53 stabilizers [PMID: 26900800], chemotherapy [PMID: 27118574].

An undated overview by Peter Wehrwein speculates that the biological mechanism may be the lowering of insulin, lowering of blood sugar output of the liver or via interruption of signalling pathways. A number of investigations have concluded that metformin acts by blocking the glucose cancer cells need and in the absence of glucose they will turn to glutamanine and leucine. They hypothesize that interfering with glutamine and leucine might synergistically work with metformin. Note that glutamine is a non-essential amino acid (i.e. the body can produce it itself) so simply lowering the intake of glutamine-containing foods might not be effective. [PMID: 23687346] [Free full text] [PMID: 26550231] [Full free text] [PMID: 24052625] [Full free text].

A 2015 meta-analysis by Wu et al found that the risk of developing prostate cancer (as opposed to the risk of death for those who have prostate cancer) is unaffected by metformin.

Confirmation of these results in diabetics and non-diabetics through randomized clinical trails is underway. See: [ClincialTrials.gov]

A video on metformin and prostate cancer by oncologist Dr. Charles (Snuffy) Myers can be viewed here: How + When to Use Metformin.

A June 2017 review paper by Whitburn et al on metformin and prostate cancer is available here:  [PMID: 28444639] [Full Free Text]

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