Is ivermectin effective for treating prostate cancer?

Ivermectin for Prostate Cancer

Ivermectin is not recommended for prostate cancer treatment and should never be used outside of clinical trials, as it has no proven therapeutic utility for cancer and is FDA-approved only for specific parasitic infections. 1

Guideline-Based Recommendations

The established treatment paradigm for prostate cancer does not include ivermectin at any stage of disease. Current evidence-based therapies include:

For Metastatic Hormone-Sensitive Prostate Cancer (mHSPC)

• First-line treatment for fit patients should be ADT + docetaxel + abiraterone/prednisone or ADT + docetaxel + darolutamide, particularly for those with multiple bone metastases (>3) or visceral metastases 2
• Alternative first-line options include novel hormone agents (abiraterone, apalutamide, or enzalutamide) plus ADT 2
• ADT alone should only be used in vulnerable patients who cannot tolerate treatment intensification 2

For Metastatic Castration-Resistant Prostate Cancer (mCRPC)

• After progression on novel androgen receptor axis inhibitors and docetaxel, use 177Lu-PSMA-617 (in PSMA-expressing tumors) or cabazitaxel 2
• Olaparib should be considered for patients with BRCA1/2 alterations after androgen receptor axis inhibitor failure 2
• Docetaxel chemotherapy is appropriate for symptomatic patients with good performance status 2

Critical Safety Concerns with Ivermectin

Higher doses of ivermectin potentially needed for anticancer effects may cause significant adverse effects, including fatal outcomes 2, 1. A documented fatal case involved transdermal overdose resulting in diffuse cerebral edema and intracranial hypertension despite aggressive treatment including hemoperfusion 3.

Why Ivermectin Lacks Clinical Utility for Cancer

• In vitro activity against cancer requires concentrations considerably higher than those achieved in human plasma and lung tissue 2
• The FDA approves ivermectin only for specific parasitic infections (onchocerciasis and strongyloidiasis), with no proven therapeutic utility for cancer 2, 1
• While preclinical studies show potential mechanisms, these findings have not translated to clinical benefit 4, 5, 6

Preclinical Data Context (Not Clinically Applicable)

Laboratory studies have identified potential mechanisms including FOXA1 and Ku70/Ku80 targeting, cell cycle arrest, and DNA damage in prostate cancer cells 4. However, these effects were observed at 5 μM concentrations that are not clinically feasible 5. The prostate cancer cell line DU145 was notably the most resistant to ivermectin among tested cancer cell lines 5.

Common Pitfalls to Avoid

• Do not prescribe or recommend ivermectin for cancer treatment - there is no authorization for this indication and no scientific knowledge supporting its application in humans for cancer 1, 7
• Patients may be attracted to ivermectin due to low cost and accessibility, particularly in resource-limited settings 1
• Anecdotal reports of patients using ivermectin alongside standard cancer therapy exist, but these do not constitute evidence of efficacy 7
• The anticancer mechanism of ivermectin remains investigational and requires further study before any clinical application 7, 6

Patients inquiring about ivermectin should be counseled about proven, guideline-recommended therapies and the lack of evidence supporting ivermectin use for prostate cancer.