Other than the conventional standard of care treatments (SOC), including ADT, surgery, radiation, and chemotherapy, the anti-PCa things that have I have found to have the most robust research are:
Diet: I cycle several diets. Keto (5-10% carbs), low-carb (15-20% carbs), high-carb whole-food plant-based (60%+ carbs). I like the one meal a day diet (OMAD). OMAD is eating all of your calories in a 1-2 hour window (I sometimes extend to 3 hours to prevent getting too full).
Exercise: 1-2 hours a day.
Phenelzine: 60 mg a day.
Statins or Red Yeast Rice (RYR): I take a high dose of one or the other (never at the same time). A high dose is 80 mg of monacolin K in RYR (20-25 tablets of HPF cholestene provide this), or perhaps 80 mg of lovastatin). I take the entire dose before I go to bed at night during a “kill” phase. I do not take any during the “recover” phase.
Metformin: 1500 mg a day.
Vitamin D: I get to my blood target using 2.5 kIU per day. I take this in the morning with 100% of the RDA of vitamin K2 (MK-4 and/or MK-7 forms). I monitor my 25-hydroxy levels and target 30 ng/ml to 60 ng/ml.
Note that the SOC treatments have large bodies of evidence and treatment history. Each can make sense depending on your status. I had RP surgery in 2019. I do not rule out radiation in the future. I wrote a post on ADT using estrogen patches and my experiences (spoiler alert: I think that estrogen patches are superior to Lupron and new clinical trials show non-inferiority – e.g., the PATCH trial). I plan to someday write a post about radiation (my current thought is that SBRT is the best option for many and can be used for all grades of PCa).
Diet: A whole-foods plant-based diet has the most evidence (WFPB). In some situations, keto makes sense but does not have much evidence around it (some research could be done but it would need to differentiate between advanced vs. non-advanced PCa – I suspect it might be negative for low-grade PCa but a positive for advanced). The Mediterranean diet also has a fair amount of population research showing that it is effective. But the comparison most often used is to the standard American diet (SAD). So, the results are kind of like concluding that eating hostess ding dongs is superior to eating arsenic. This applies to much of the research around plant-based diets and keto diets also.
Some links:
Exercise:
45-90 minutes a day seems best. Too much can be a negative. Research shows that splitting the exercise up into shorter bursts throughout the day is much better than doing it all at once. I spend about 60 minutes on average with heavy weights and 30 minutes a day with moderate cardio (I prefer biking).
https://cancerpreventionresearch.aacrjournals.org/content/8/7/597
Phenelzine (brand name Nardil):
I take 60 mg a day and I split this into two 30 mg doses.
Chemotherapy-Induced Monoamine Oxidase Expression in Prostate Carcinoma Functions as a Cytoprotective Resistance Enzyme and Associates with Clinical Outcomes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157741/
USC researchers use decades-old antidepressant to combat prostate cancer – Ellison Institute for Transformative Medicine https://ellison.usc.edu/2020/03/03/maoi-prostate-cancer/
Phase 2 trial of monoamine oxidase inhibitor phenelzine in biochemical recurrent prostate cancer – PubMed https://pubmed.ncbi.nlm.nih.gov/32123315/
USC study shows MAO-A may be effective in treating prostate cancer https://news.usc.edu/146963/usc-study-mao-a-for-treating-prostate-cancer/
Effect of Monoamine oxidase A (MAOA) inhibitors on androgen-sensitive and castration-resistant prostate cancer cells – PubMed https://pubmed.ncbi.nlm.nih.gov/30693539/
Loss of MAOA in epithelia inhibits adenocarcinoma development, cell proliferation and cancer stem cells in prostate | Oncogene https://www.nature.com/articles/s41388-018-0325-x
Anti-oncogenic and pro-differentiation effects of clorgyline, a monoamine oxidase A inhibitor, on high grade prostate cancer cells https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736984/
1950s depression pill could be used to treat prostate cancer | Daily Mail Online https://www.dailymail.co.uk/health/article-8979007/A-depression-pill-70-years-ago-used-treat-prostate-cancer-research-suggests.html
MAOA promotes prostate cancer cell perineural invasion through SEMA3C/PlexinA2/NRP1–cMET signaling | Oncogene https://www.nature.com/articles/s41388-020-01615-2
Adherence to antidepressant medications is associated with reduced premature mortality in patients with cancer: A nationwide cohort study – PubMed https://pubmed.ncbi.nlm.nih.gov/31332883/
Antidepressants protect bones from metastatic prostate cancer – PubMedhttps://pubmed.ncbi.nlm.nih.gov/28351947/
Phase II Trial Results Show Promise for Phenelzine in Prostate Cancer https://www.cancernetwork.com/view/phase-ii-trial-results-show-promise-phenelzine-prostate-cancer
Antidepressant shows promise in treating recurrent prostate cancer https://news.usc.edu/166277/antidepressant-prostate-cancer-mao-inhibitor-phenelzine/
Effect of Monoamine oxidase A (MAOA) inhibitors on androgen-sensitive and castration-resistant prostate cancer cells https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462252/
Effects of the monoamine oxidase inhibitors pargyline and tranylcypromine on cellular proliferation in human prostate cancer cells https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810355/
Metformin alone
I take 1000 – 2000 mg a day – on days when I take 1000 mg I take it all at once, otherwise, I split into 2 or 3 doses.
Metformin and also info on statins:
https://www.frontiersin.org/articles/10.3389/fphar.2019.00203/full
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962745/
https://pubmed.ncbi.nlm.nih.gov/27492013/
Statins with ADT and/or abiraterone acetate (Zytiga) and/or enzalutamide (Xtandi):
https://pubmed.ncbi.nlm.nih.gov/31951037/
Vitamin D:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240137/
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170791
To interpret the vitamin D serum levels, one needs to be careful about units of measure. Much of the research is in nmol/L but the standard lab measurement in the U.S. is in ng/ml. I made this mistake and overshot the sweet spot. I reduced my D supplementation and now I should be in range. My take on the “sweet spot” is that it is 30 – 55 ng/ml.
An effective Red Yeast Rice (RYR) could be used in place of a statin. To judge a particular RYR brand’s effectiveness, either look at 3rd party lab results or check your cholesterol; preferably both. RYR might be even more effective for cancer than a statin. However, currently, we do not have enough data to conclude that.
RYR:
https://www.frontiersin.org/articles/10.3389/fphar.2019.01449/full
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2587076/
Lovastatin vs. RYR:
https://pubmed.ncbi.nlm.nih.gov/19053857/
https://sci-hub.se/https://www.liebertpub.com/doi/10.1089/jmf.2007.0702
Prostate Cancer Adventures 