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Does Your Gut Microbiome Affect Prostate Cancer Treatment?

Medically reviewed by Steven N. Gange, MD, Susan Kerrigan, MD and Marianne Madsen on February 22, 2022

Do you remember learning to wash your hands? Your school may have shown you cartoon bacteria that resembled scary monsters. They may have had sharp teeth and hands that extended from their bodies to grab you (or just make you sick somehow). You may have been taught how to wash away the bad germs to be healthy and safe. Do you then remember years later how shocked you were to learn that not all germs are “bad”? That there are actually “good” germs that help strengthen the body?


“Good germs” have a great effect on gut health. This topic has become a popular research trend over the past few years. Scientists have dedicated more time to understand how probiotics, the healthy bacteria in our gut, can improve our overall wellness. Probiotics are a part of the microbiome, a complex system of bacteria, fungi, and viruses that live in our body and promote its growth. However, sometimes even our healthy bacteria can harm us. 


Research has found that prostate cancer patients may suffer from having an overactive microbiome. An expansive microbiome can promote the growth of androgen and reverse the effects of hormone therapy. Hormone therapy is the primary treatment used to combat prostate cancer.  It focuses on destroying the male hormone, androgen, to suffocate cancer cells and wipe them out. Despite this dismal news, there is also hope. Scientists have detected a fingerprint in the microbiome of prostate cancer patients that can help identify patients at risk of developing prostate cancer while still in the early stages.


How does hormone therapy work?


The goal of hormone therapy is to reduce the amount of androgens in the body. Some forms of the therapy prevent androgen from being produced and others prevent androgens from reaching the cancer cells. It may seem counterintuitive to stop androgen production, since hormones are an important part of body function. However, they also help prostate cancer cells grow and spread. Cutting back on androgen production also cuts back cancer cells’ source of nutrition. Hormone therapy alone does not prevent cancer from coming back. However, when used in conjunction with other therapies, such as radiation therapy, it can help slow the rate of cancer growth.


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Prostate Cancer - Hormone Therapy

Prostate Cancer - Hormone Therapy

How does the microbiome resist hormone therapy? 


Once a patient begins hormone therapy for prostate cancer, his body begins to react to the androgen deprivation. The microbiome jumps into action and starts producing hormones. This may explain why hormone therapy stops working after some time. When the microbiome begins churning out new androgens, prostate cancer cells have a new source of nourishment.


What about the “fingerprint?”


True, the news that the microbiome can cause resistance to hormone therapy is not a reason to celebrate. However, the discovery of a special microbiome signature is a good excuse to let out a “hurrah!” Men who have these “gut bugs” in their microbiome, those that reverse the effects of hormone therapy, also have a special pattern of microbes that identify them as “therapy resistant.” If doctors can catch these patterns in their patients while in the early stages of cancer, they can develop therapies to help them before their condition worsens. Treatments such as fecal transplants (a therapy in which healthy stool is transplanted into the patient’s gut to alter the harmful bacteria living there) and antibiotic therapy can help adjust the microbiome to comply with hormone therapy. This new and improved microbiome can improve results of therapy, ultimately prolonging the lives of prostate cancer patients.


The latest news from the scientific front may make gut bacteria out to be the nasty caricatures that we learned about as kids. However, even when our good bacteria is “misbehaving,” it’s doing so to make the body stronger. The microbiome “knows” that the body needs androgens to perform properly, so it tries to “help out” by making more hormones when the supply is low, not realizing the damage it is doing. It’s up to doctors to tweak and guide the microbiome to ensure that it doesn’t harm the body it’s trying to protect. These discoveries will help develop new tests and therapies so that when our friend becomes an enemy, we can bring the microbiome back on our side.


Written by Chani Bonner

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