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HIV Prostate Cancer Survivor dealing with Lipodystrophy
Oct 18, 2011

Have recently gained alot of body fat & because I had my prostate removed succesfully 2 years ago I have been told that I am unable to be a candidate for Agrifta? Any suggestions to deal with this depressing weight situation?

Response from Mr. Vergel

In its package insert, Egrifta does not have a contraindication for patients like you. However, I can see why your doctor may be hesitant to prescribe it since Egrifta increases levels of Insulin-Like Growth Factor-1 (IGF-1), which not only is linked to fat loss and lean body mass gain, but potentially with increased malignancies. The FDA has requested a phase 4 study to see if Egrifta does indeed increase the rate of cancer in patients.

I am not sure if you have got your testosterone blood levels checked or if you are one of those patients whose doctor refuses to give any hormone replacement therapy due to your cancer history. Some doctors, after proving that there is no prostatic cancerous tissue remaining and depending on your baseline cancer grade before prostactectomy, have successfully used testosterone replacement in patients like you. Depending on the dose and the patient, testosterone can also increase IGF-1. Testosterone replacement can decrease subcutaneous fat and increase lean body mass, sex drive and stamina. But many doctors are afraid to use it in patients like yourself. You may want to read this report presented this year from work done in Houston: Testosterone replacement therapy found safe in study of high-risk post-radical prostatectomy patients

Cancer can return in men that undergo prostate removal depending on several factors like the Gleason score before removal, so some doctors may be more conservative with men that presented with higher Gleason scores prior to surgery. I am not sure what your Gleason score was before your prostate removal. You can read more about this in this abstract: Prediction of Progression Following Radical Prostatectomy: A Multivariate Analysis of 721 Men with Long-term Follow-up Of course, I am not advocating starting any hormone replacement therapy. Only your urologist can recommend what to do.

Exercise and a high fiber, low animal fat, high protein diet may be all you can do now. I am not sure how your energy level is after surgery, though, for you to exercise.

Hang in there. It will take some work for you to lose weight naturally without hormones, but hopefully with some help you can do so. I hope you have access to an exercise trainer and a referral to a good dietitian where you live. Please do not hesitate to ask me more questions related to your issue since I think it is one of the more challenging ones and something that we may see more of as we age with HIV.

Nelson



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