DEAR DR. ROACH: In 2022, my primary care doctor recommended that I get a PSA test. Even though I did not believe in it, he was a very caring doctor, so I had the test done. My result showed a PSA score of 38 ng/mL. I saw a urologist and had a biopsy that showed cancer, so I was started on Lupron.
After six months, I told the urologist that I did not like Lupron because I experienced hot flashes. He recommended radiation treatment. I had more X-rays done, and they found that the cancer had spread to the bone on my left side. I received radiation to the prostate, as well as radiation to the bone where the cancer had spread.
A new doctor recommended that I start a new medication regimen: abiraterone with prednisone. I feel blessed, as I have no side effects. I’ve had continued checkups, and my PSA score is now 0 ng/mL.
My question is: Should I continue taking abiraterone and prednisone, as I really don’t want to take more medicines than I need to? — M.A.
ANSWER: First off, your story shows why screening for prostate cancer is important, since it can save lives by finding cancer when it is still curable. Once the cancer has spread, it is not curable, but new treatments like what you are taking can keep the disease in check, often for a long time.
Radiation is an effective way to control localized prostate cancer, but medications are the mainstay of therapy for when prostate cancer has spread. The combination has worked very well for you, as evidenced by your PSA level of 0 ng/mL. However, I strongly believe you should continue your medication, since I believe it is preventing any residual prostate cancer cells from growing.
If you were to stop abiraterone (which works by blocking testosterone), it is likely that the cancer would come back more quickly. Prednisone is given to help prevent an excess of a different hormone class, called mineralocorticoids, which can lead to high blood pressure and low potassium.
The fact that you are feeling great and not having side effects is great, and it makes me more likely to recommend continuing abiraterone and prednisone.
DEAR DR.
ROACH: Could you please comment on keto and apple cider vinegar (ACV) gummies for weight loss?
They are promoted by celebrities, and the gummies supposedly get rid of belly fat. Do they work? Are there any side effects? — J.B.
ANSWER: ACV has been touted as a cure for many different conditions. Putting it in gummies makes it more palatable, but it doesn’t provide a lot of ACV. More importantly, there really isn’t any proven benefit for weight loss, and I doubt that even a very large study would prove it effective. (I’ll change my mind if a large study does prove it effective.)
Furthermore, even when a person is losing weight, it is impossible to tell your body where you want it to lose weight from, whether it’s the abdomen, hips or breasts. I have had many patients get upset that they lost weight where they didn’t want to.
Side effects include damage to the teeth and problems from taking in sugar. (An ACV gummy contains 1 gram of sugar on average, which adds up if you are taking a lot.) The gummies are not regulated by the Food and Drug Administration, so you are relying on the manufacturer to put in what they say they do.
Finally, I wouldn’t want a person to take these instead of having a good diet and getting regular exercise, which provide many benefits.
