Metformin in the management of ADT-related side effects and morbidities

A newly published article in BJU International offers data from a small, randomized, pilot study of the use of metformin and lifestyle changes in the prevention of cardiovascular morbidity and androgen deprivation therapy (ADT)-related metabolic syndrome. As far as we are aware, this is the first published study to address this method for the prevention of cardiovascular morbidity and ADT-related metabolic syndrome in men with progressive forms of prostate cancer who were receiving treatment with ADT.

Nobes et al. recruited 40 men with prostate cancer who were already scheduled to receive treatment with ADT. The men were randomized to be treated for 6 months with one of two regimens:

  • ADT + metformin + a diet with a low glycemic index + a specific exercise program (Group A)
  • ADT alone (Group B)

All patients were carefully assessed pre-treatment for ADT-related metabolic syndrome and again after a period of 6 months. Related biochemical and physical parameters were carefully recorded.

The results of the study are as follows:

  • 20 patients were randomized to each study arm of the trial.
  • At 6 months of follow-up, compared to patinets in Group B, patients in Group A demonstrated better (i.e., more normal measures of)
    • Abdominal girth (P = 0.05)
    • Weight (P < 0.001)
    • Body mass index (P < 0.001)
    • Systolic blood pressure (P = 0.01)
  • There were no significant differences among the biochemical markers of insulin resistance between patients in the two groups.

The authors conclude that, “The present study shows the potential benefits of metformin and lifestyle changes in ADT-treated men. Further studies will aim to determine which intervention is most important, and may show that overall survival can be improved.”

Metformin is an insulin sensitizer. The benefits of this drug, used in combination with lifestyle intervention, are widely appreciated in the management of patients with poor levels of glucose tolerance. The logic that addition of metformin along with lifestyle management to ADT in men with progressive forms of prostate cancer makes complete sense. Even so, the initial data from this study are surprisingly good.

Metformin — like all other drugs — does, however, have side effects. These side effects may make it an inappropriate form of therapy for some men taking ADT. Metformin may also, rarely, cause a serious, life-threatening condition known as lactic acidosis. Men on ADT should only consider the additional use of metformin after careful consultation with their physician.

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