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Mitigating Risk of Recurrence
After being diagnosed earlier this year with NMIBC (T1), I’ve been through the initial TURBT, a restaging TURBT, and am now scheduled to start BCG. At the same time, I’m trying to do everything under my direct control to decrease chance of recurrence. Welcome feedback on the following things I’ve come up with, and anything more that could be added.
A. Thyroid Hormone: a few months before being diagnosed with BC, I was referred to an endocrinologist based on high TSH and diagnosed with subclinical hypothyroidism. I was prescribed a thyroid hormone called levothyroxine, which I read has been proven to increase risk of cancer. The endocrinologist claimed it’s perfectly safe, but I stopped taking it anyway. Is this overkill?
B. Blood Pressure Meds: For the last decade, I’ve been taking a combined blood pressure medication made up of olmesartan, amlodopine, and hydrochlorothiazide. There are studies showing some blood pressure medications can increase risk of cancer, but it’s not clear to me whether these are in that category. I’m continuing to take them, but should I try to change?
C. Diet/Nutrition/Exercise/Sleep: I’ve switched to a mediterranean diet and am mostly vegetarian now with no red meats or nitrates. I drink a ton of water. I walk 2-3 miles a day. I try to get 7 hours of sleep each night. I’ve lost about 30 pounds since my original diagnosis but am still overweight. My hope is that I can get off the blood pressure meds if I thin down. I haven’t smoked in 20 years.
Is there anything else we have control over that may help mitigate risk of recurrence? Willing to try just about anything… Thanks!!!
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8 Replies
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Congrats on completing the 6 weekly BCG induction treatment. I am aware that there are some patients who cannot complete the first 6 treatment because of severe side effects. I hope the first cystoscopy goes well and go on to the first 3 weekly maintenance treatment.
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I recently completed my 6-week induction period of full dose BCG. I wish I could say I handled it like a pro, but I don’t think I’ll ever be able to fully relax during the catheter procedure, even with a mild benzo. I did survive however and seemed to have tolerated the BCG itself. Next step will be getting scoped in about a month.
Also I did restart my levothyroxine. My endocrinologist knew nothing about the interplay of the endocrine and immune systems — but after speaking to multiple sources it seems the chances are miniscule of the levothyroxine increasing risk of cancer recurrence, to the chance of benefits outweighs the risks. Good recommendation.
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Joe thanks for the info, particularly the association between thyroid hormone levels and immune system efficacy. I did have a consultation with my endocrinologist but he was not super helpful, repeatedly calling this an academic topic, and underscoring that his experience was purely clinical and he could not offer anything. He only reinforced that it would not hurt anything to restart the levothyroxine to normalize my thyroid hormone levels. I think I probably picked the wrong endocrinologist, but lead times are several months out for new ones.
I do see some research online that suggests that out-of-control overt hypothyroidism is associated with a weakened immune system. However, that doesn’t describe me — my T3 and T4 levels are within normal range and I’ve always had a pretty good immune system, if I can count being sick less frequently than my family members living under the same roof. So I’ll have to think real hard about restarting levothyroxine given its association with higher risk of cancer.
On the BCG treatment, I did feel tired/fatigued/achy starting a couple days afterwards, but no severe reaction otherwise. The hospital where I’m getting treated doesn’t have a room for me to lay down and roll around like a rotisserie chicken, so I have to drive home afterwards (about 30 min door to door) and then lay on my bed for the quarter turns. I’m not a huge fan of losing that 30 minutes sitting upright but will have to make due.
Thanks for all the tips.
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“G. More cranberry and pomegranate juice – have read it prevents cancer.” Those are antioxidants, and those are proven to help. You are on some similar blood pressure meds I have. Beta blocker, channel blocker and ARBs that I have had for 25 years, light to medium dose. My cardio nor URO have ever warned on any of this. We can over think sometimes. So many new pharmacy/med ads mention so many things to avoid it becomes humorous. You would never take anything.
Just use common sense. I quit carbonated sodas 16 years ago. While it didn’t cause my cancer, it still can be an irritant to your system. Ever put a dirty penny in a cola overnight. It comes out much cleaner. Same principle.
I was treated with BCG treatment. I did fine until after last treatment. I felt like I was hit by a truck. I now get up every hour to pee. I am exhausted. Has anyone found a way to cope with it. Thanks Glenn
I think its great that you quit smoking 20 years ago and getting in a good shape and sleeping 7 hours. I am not dietician so I don’t have much input on how diet affects on prognosis of bladder cancer. In terms of what you take into your body, I would read “Eating Hints:
Before, during, and after
Cancer Treatment’ published by National Cancer Center(NCI). The publication says that there are no studies that prove that any special diet, food, vitamin, mineral, dietary supplement, herb, or combination of these can slow cancer, cure it, or keep it from coming back.https://www.cancer.gov/publications/patient-education/eatinghints.pdf
Since you were already diagnosed with non muscle invasive bladder cancer (T1HG), and already scheduled for BCG treatment in near future, I think the strategy for reducing the probability of recurrence and progression should be helping the BCG treatment work as best as possible. By having hypothyroid and not taking recommended a thyroid hormone called levothyroxine may affect the effectiveness of BCG treatment.
BCG is attenuated live bacteria which can cause tuberculosis in cattle and other animals. As matter of fact, BCG bacteria. In a single treatment of BCG, over billions of bacteria are instilled into bladder. Those billions of BCG bacteria infect not only bladder cancer cells but also healthy cells. When this happens, various immune cells respond to the invasion and infection by BCG bacteria. The effectiveness of BCG treatment depends upon how well the immune system responds. How well the immune system responds is closely linked thyroid hormones.
You were diagnosed with high TSH and subclinical hypothyroid. High amount THS (Thyroid -Stimulation Hormone) is produced because the body is telling thyroid to produce more thyroid hormone because it thinks thyroid is not producing enough thyroid hormone, which is a condition of hypothyroidism. It also means that sufficient amount of thyroid hormone may not exist for immune system to be effective.
Look at Figure 2 of the publication titled “The interplay of thyroid hormones and the immune system”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9010816/
You see thyroid hormone T3, T4 are interacting with Neutrophil, NK cell, B-cell, T-cell, Monocyte, Dendritic cell and Macrophage. Those immune cells are activated by BCG treatment and utilized to kill bladder cancer cells. So, by having deficient amount of thyroid hormone may hinder the effectiveness of BCG treatment,
I would strongly suggest you to talk the endocrinologist about the interaction between thyroid hormone and immune system.
And also:
F. Less processed sugars (including carbs) – have read that processed sugars “feed” cancer.
G. More cranberry and pomegranate juice – have read it prevents cancer
H. Vitamin C – have read it prevents cancer. Have read Vitamin E does the opposite.
I almost forgot:
E. OTC Meds: I take a daily baby aspirin to thin my blood due to polycythemia (overproduction of red blood cells). I’ve seen mixed studies on aspirin — some claim it prevents cancer, others say it increases the risk. Any consensus on what effect it has on bladder cancer?
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