Ivermectin Should Not Be Used to Treat Prostate Cancer
Ivermectin is not recommended for prostate cancer treatment and should be actively discouraged, as no major oncology guideline supports its use, and established evidence-based therapies with proven survival benefits are available. 1, 2
Why Ivermectin Is Not Appropriate for Prostate Cancer
Absence of Guideline Support and Clinical Evidence
The European Society for Medical Oncology explicitly recommends against using repurposed medications, including ivermectin, for prostate cancer treatment due to lack of survival benefit. 2, 3
No major oncology society—including ESMO, ASCO, or NCCN—includes ivermectin in treatment algorithms for any stage of prostate cancer (localized, metastatic hormone-sensitive, or castration-resistant disease). 1, 2
The IDSA guidelines strongly recommend against ivermectin use even in COVID-19 treatment (where it was extensively studied), demonstrating that despite theoretical mechanisms, clinical efficacy has not materialized in human trials. 1
The Preclinical-Clinical Evidence Gap
While preclinical studies show ivermectin can inhibit prostate cancer cell proliferation, induce apoptosis, and target proteins like FOXA1 and Ku70/Ku80 in laboratory settings, these findings have not translated to proven clinical benefit in human patients. 4, 5
The most resistant prostate cancer cell line to ivermectin in preclinical studies was actually DU145, a prostate cancer cell line, suggesting limited efficacy specifically in prostate malignancies even in controlled laboratory conditions. 6
No large-scale randomized controlled trials in humans have confirmed therapeutic benefits of ivermectin for any cancer type, creating a critical translational gap between laboratory results and clinical application. 7
Risks of Self-Medication and Misinformation
Observational studies document toxicity in oncology patients who self-medicate with ivermectin based on social media misinformation, leading to adverse events without therapeutic benefit. 7
Patients using ivermectin may delay or forgo proven therapies with established survival benefits, resulting in disease progression during the window when curative or life-prolonging treatment could be effective. 7, 8
Evidence-Based Alternatives with Proven Survival Benefits
For Metastatic Hormone-Sensitive Prostate Cancer
First-line treatment should be ADT combined with novel hormone agents (abiraterone, enzalutamide, apalutamide, or darolutamide) or ADT plus docetaxel for fit patients. 1, 2, 9
Triplet therapy (ADT + docetaxel + abiraterone or darolutamide) is recommended for fit patients with de novo metastatic disease, showing 4-year overall survival of 62.7% versus 50.4% with placebo (HR 0.68). 2, 9
For Castration-Resistant Prostate Cancer
Abiraterone or enzalutamide are recommended for chemotherapy-naïve patients with metastatic CRPC. 1, 2
Docetaxel demonstrates proven survival benefits with hazard ratios of 0.68-0.76 for overall survival. 2, 3
For patients with BRCA1/2 alterations after androgen receptor axis inhibitors, olaparib is recommended. 2
For PSMA-expressing tumors after taxane and novel androgen receptor axis inhibitor failure, 177Lu-PSMA-617 is recommended. 2
Clinical Communication Strategy
Addressing Patient Inquiries About Ivermectin
Acknowledge that laboratory studies show anticancer effects but emphasize these have not translated to human benefit in clinical trials. 4, 7, 5
Explain that the concentrations required for anticancer effects in laboratory studies may not be safely achievable in human patients, and that ivermectin carries cardiovascular and other toxicity risks. 3, 7
Redirect patients toward guideline-concordant therapies that have demonstrated overall survival improvements in phase III randomized controlled trials. 1, 2
Common Pitfalls to Avoid
Do not dismiss patient concerns about treatment costs or accessibility without offering concrete alternatives, as affordability concerns may drive interest in repurposed drugs. 7
Avoid simply stating "no evidence" without explaining the specific gap between laboratory findings and clinical outcomes, as patients may have seen preclinical data online. 7, 5
Counter misinformation proactively by explaining that rigorous clinical trials are needed before any agent can be recommended, regardless of promising laboratory results. 7