PROLACTIN LEVEL Compiled by Charles (Chuck) Maack – Prostate Cancer Advocate/Activist Disclaimer: Please recognize that I am not a Medical Doctor. I have been an avid student researching and studying prostate cancer as a survivor and continuing patient since 1992. I have dedicated my retirement years to continued research and study in order to serve as an advocate for prostate cancer awareness, and, from a activist patient’s viewpoint, to help patients, caregivers, and others interested develop an understanding of prostate cancer, its treatment options, and the treatment of the side effects that often accompany treatment. Readers of this paper must understand that the comments or recommendations I make are not intended to be the procedure to blindly follow; rather, they are to be reviewed as my opinion, then used for further personal research, study, and subsequent discussion with the medical professional/physician providing prostate cancer care. Check “fasting” prolactin level since prolactin SENSITIZES the AR (androgen receptor) and also inhibits Dopamine thus favoring angiogenesis. From: http://www.drmyattswellnessclub.com/prostatecancer.htm “Prolactin hormone is an additional growth factor to the prostate gland, and rising prolactin levels correlate with progression in advanced prostate cancer cases. Prolactin receptors are found on prostate cancer cells, and it is postulated that these receptors may facilitate the entry of testosterone into the cell. Even with hormone ablation therapy, detectable androgen remains in the blood from adrenal sources. Blocking prolactin secretion may therefore be another method for slowing progression of the disease. It is recommended that prolactin levels be kept below 3 in all patients with hormone-responsive cancers.” Medical Oncologist Stephen Strum provided the following effects of increased prolactin levels at the 2012 PCRI Conference on Prostate Cancer and has commented since in posts to the physician to patient (p2p) prostate cancer support list: Prolactin actions: In the case of being treated with Sequential Androgen Blockade (SAB) with an antiandrogen and 5Alpha Reductase (5AR) inhibitor: SAB will allow continued normal testosterone levels and the testosterone will be metabolized to estradiol which will cause gynecomastia/breast enlargement, and with that, nipple hypersensitivity. If a man is going to be treated with agents that raise testosterone then an aromatase inhibitor should be used to prevent elevation in estrogen. With an estrogen elevation comes a prolactin increase and prolactin is not something you want high normal or elevated in PC. Prolactin actions: 1) acts synergistically with LH to stimulate testosterone secretion from testicles by increasing the number of LH receptors in the testis; 2) influences adrenal androgen formation; 3) enhances testosterone uptake by prostatic cells; 4) alters intra-prostatic androgen metabolism 5) increases uPA to dissolve ECM (extracellular matrix) and facilitate spread of CA 6) enhances angiogenesis 7) decreases libido 8) decreases cognitive function An explanation of the effect of angiogenesis on cancer tumors is explained here: http://www.cancer.gov/cancertopics/understandingcancer/angiogenesis At another time, Dr. Strum remarked: “If the fasting prolactin is 5.0 or higher, start Dostinex (cabergoline) at 0.25 mg every Monday, Wednesday, and Friday. A month later recheck the prolactin level.” He added, however, that he looks at the Biological End Point (BEP). If he starts with a lower dose, there is usually an issue of not such an elevated prolactin concern – or he may consider the cost of the generic to a patient. Then when he re-tests the prolactin level, he may leave the dose as is if the BEP is achieved (<5.0ng/ml), or raise the dose if not. On the other hand, he may start at a higher dose such as 0.5mg three times a week, particularly if the prolactin level is more significantly elevated. Then, when he re-checks the level, and depending on the result, may elect to continue at 0.5mg three times a week, or may reduce the dose to 0.25mg three times a week, or even twice a week. He compared his reasoning to that of detective Jack Webb in the “Dragnet” TV series of long ago – “The facts, ma’am, just the facts.” But in this case, “The BEPs man, just the BEPs.” All of the above puts Prolactin into the #1 spot as the most neglected hormone in discussions of men with PC and the topic of ADT (androgen deprivation therapy). MORE PROLACTIN and PROSTATE CANCER Prolactin in Breast and Prostate Cancer: Molecular and Genetic Perspectives http://tinyurl.com/knzagd4 Scroll down to “Prostate Cancer” and read all below relating to Prolactin playing a role in aggressiveness of prostate cancer development. ANOTHER Beyond PSA Elevated Prolactin Levels: Another Major Risk Factor for Prostate Cancer http://tinyurl.com/lqm8rn9 “Prolactin has recently entered the limited panel of nonandrogenic signaling pathways that are emerging as potential candidates for targeted therapy in a subset of prostate cancer patients. Indeed, evidence has accumulated within the past few years to suggest that activation of Stat5, the downstream effector of the canonical PRLR [prolactin receptor] signaling pathway, has a key role in prostate cancer progression.” MORE IN THE FOREGOING PAPER: “analysis of human prostate cancer specimens showed prolactin immunostaining in 54% of a series of 80 prostate cancer specimens, and was positively correlated with high Gleason scores and activation of Stat5a/b, its major signaling protein. Furthermore, prolactin was also expressed in 50% of recurrent prostate cancer samples in a series of 183 specimens, including hormone-refractory cancer (54% of positive cases), and those from patients with lymph node metastases (67%). ANOTHER PROSTATE CANCER (EARLY STAGE) http://www.lef.org/protocols/prtcls-txt/t-prtcl93.htm “Studies have shown that prolactin also may be involved in prostate growth. A rising serum level of prolactin indicates progression in patients with advanced prostate cancer. The presence of prolactin receptors in prostate cancer cells may facilitate the entry of testosterone into prostate cells. Since testosterone-blocking therapies do not completely eliminate testosterone from the blood, it is conceivable that prolactin could carry a small amount of residual testosterone into the prostate cells and cause cancer growth. Thus, suppressing prolactin secretion with relatively safe prescription drugs appears to be another method of slowing the progression of prostate cancer.” ANOTHER Autocrine prolactin promotes prostate cancer cell growth via Janus kinase-2-signal transducer and activator of transcription-5a/b signaling pathway. http://www.ncbi.nlm.nih.gov/pubmed/17412813 “The study also provides support for the use of Prl receptor antagonists or other therapeutic strategies to block the Prl-Janus kinase-2-Stat5 signaling pathway in advanced prostate cancer.” And finally (and remember to “fast” for the 8 hours leading up to the blood draw: People with the following conditions may have high prolactin levels:       Chest wall trauma or irritation Hypothalamic disease Hypothyroidism Kidney disease Pituitary tumor that makes prolactin (prolactinoma) Other pituitary tumors and diseases Certain medications can also raise prolactin levels, including:    Antidepressants Butyrophenones Estrogens        H2 blockers Methyldopa Metoclopramide Phenothiazines Reserpine Risperidone Verapamil If your prolactin levels are high, the test may be repeated in the early morning after an 8-hour fast. NOTE: If your insurance doesn’t cover oral medications or you don’t have insurance, you may want to consider ordering the generic Cabergoline from the following overseas source wherein ordering 16 of 0.5mg tablets that can be split in half for the 0.25mg dose costs around $25.00 plus S&H. Or you can order more or later order refills as needed: https://www.alldaychemist.com/supplier.php?id_supplier=68