There is good reason, now, it appears, for men with advanced (metastatic) prostate cancer to prepare for possible Alzheimer's disease if they need to go on hormone treatment - -which most will. There are, of course, different stages, even for metastatic disease in which the prostate cancer cells have migrated into bones (see graphic above). The 'trick' is knowing when to begin. The advice of Hopkins oncologist Dr. Patrick Walsh has consistently been don't start too early - especially if there are no manifest symptoms (i.e. blood in urine or stool, blockage of urination, extreme bone pain in spine, pelvis, limbs).
For me right now, diagnosed with "castrate-resistant metastatic disease" via a PSMA scan back in July, 2022,
PSMA Scan Confirms Cancer Is Metastatic (As Well As Localized) - And Urgent Action Is Needed
I am on the more conservative mode of ADT via monthly Firmagon (degarelix) injections, e.g.
These are painful as hell - like a hornet's sting (with swelling) in the belly each time, this on account of the semi-solid 'depot'
formed after injection, which then supplies a continuous release of the Firmagon over time. But even then I was aware of the possibility of developing Alzheimer's disease because of earlier research that had emerged. To wit, a 2019 study out of the University of Pennsylvania’s Perelman School of Medicine. The study found a link between drugs commonly used for ADT and an increased risk of dementia.
It included 154,089 men whose average age was 74 and who had
diagnoses of prostate cancer. Of these, 62,330 received ADT and the rest
did not. The study found a link between drugs commonly used for hormone therapy
and an increased risk of developing dementia including Alzheimer's disease.
After 5 years the risk ballooned to nearly 50%.
For this reason I have kept to just the Firmagon as opposed to adding abiraterone as well (which the urologist recommended) which would go after all the testosterone everywhere including in the adrenal glands.
Thus far the plan has worked, keeping the testosterone at near nadir levels and the PSA below 3.0 (with the exception of two severe lung infections in February and August which saw the PSA spike to 4.7 and 3.3, respectively).
More recent research confirms my choice, as reported in a Stanford University paper. Noting that androgen is "a key regulator of amyloid". Hence when it is removed - testosterone radically lowered as in ADT - then more amyloid is left to form plaques, the hallmark of Alzheimer's disease. In the words of Qin Wang, Georgia Research Alliance Eminent Scholar in Neurodegeneration quoted in the paper:
“We know that prostate cancer itself also largely affects men over age 65, which is a population that’s already at a higher risk of Alzheimer’s, simply due to their age. What is not largely understood is the role ADT may play in the context of cancer and Alzheimer’s disease.”
Wang and her research team suspected an over-reactive immune response and subsequent inflammation may also be in play - and used an animal model to confirm it. Basically, seeing an enhanced release of cytokines following a "high amount of reactivity in glial cells" for the group treated with ADT. (Glial cells typically support brain neurons and help them function properly).
Specifically, ADT is linked to neuro-inflammation through the release of pro-inflammatory cytokines (e.g. IL- 1β , IL-6, TNF- α , and IL-10) which leads to cognitive impairment and reduced brain health. In particular, Interleukin - 1β , a key cytokine released by microglia, astrocytes and neurons increases the accumulation of amyloid-beta (A- β) plaques which exacerbates inflammation and neuronal damage precipitating Alzheimer's onset.
The 'good news' if there is any? Given that I've rejected the added use of abiraterone (to lower testosterone everywhere), the cancer may well likely get me before the Alzheimer's.
See Also:
- And:
Prostate Cancer and Androgen Deprivation Therapy (youtube.com)
- And:
- And:
- And:
Prostate Cancer and Bone Metastasis
No comments:
Post a Comment