Metformin May Mimic Exercise Benefits for Men with Prostate Cancer

Common diabetes drug could help address hormone therapy-related metabolic issues.

Apr. 6, 2026 at 2:56pm

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A ghostly, translucent X-ray image of a human prostate gland, its internal structures revealed as glowing lines against a dark background, conceptually illustrating the metabolic impacts of prostate cancer treatment.An X-ray view of the prostate gland offers a glimpse into the metabolic changes that can occur in men with prostate cancer undergoing hormone therapy.Today in Miami

A study found that men with prostate cancer who took the diabetes medication metformin had elevated levels of the metabolite N-lactoyl-phenylalanine (Lac-Phe), which is known to increase with physical activity in healthy people. Researchers believe metformin could help men with prostate cancer who develop hormone therapy-related metabolic syndrome, a major problem that can lead to treatment failure and death.

Why it matters

Obesity and metabolic dysfunction are major issues for men with prostate cancer, especially those on hormone therapy which can exacerbate cardiovascular risks and lead to weight gain and muscle loss. Finding ways to address these metabolic side effects is crucial for improving quality of life and treatment outcomes.

The details

The study evaluated serum samples from over 30 prostate cancer patients, finding those who took metformin had significantly elevated Lac-Phe levels similar to what is seen in people who exercise intensely. Researchers believe metformin may be able to 'recapitulate the benefit of exercise' for these patients, many of whom struggle with mobility and muscle loss due to their cancer treatment.

  • The initial observations that prompted this research came about 10 years ago when a researcher noticed some of his prostate cancer patients on metformin for metabolic issues had unexpectedly declining PSA levels.
  • The BIMET-1 randomized phase 2 trial evaluating metformin with the antiandrogen drug bicalutamide was conducted several years ago.
  • The latest research analyzing Lac-Phe levels in over 30 prostate cancer patients was done in the last few years at the University of Miami.

The players

Marijo Bilusic

Professor of clinical medicine at University of Miami Miller School of Medicine and genitourinary medical oncologist at Sylvester Comprehensive Cancer Center.

Priyamvada Rai

Professor of radiation oncology at University of Miami Miller School of Medicine and co-leader of the Tumor Biology program at Sylvester Comprehensive Cancer Center.

Veronica L. Li

Research scientist at Stanford University who published data showing exercise causes production of the metabolite Lac-Phe.

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What they’re saying

“Hormone therapy ages prostate cancer patients very quickly by increasing the risk of frailty, cognitive decline and cardiovascular disease. A significant number of our patients with prostate cancer die from cardiovascular disease (heart attack and stroke), and they have metabolic syndrome caused or worsened by treatment.”

— Marijo Bilusic, Professor of clinical medicine and genitourinary medical oncologist

“The overarching promise of our study is the potential impact on how we can improve the quality of life of the patients who are on hormone therapy, in whom cancer treatment is inducing metabolic syndrome, and how we can help them to reverse that process.”

— Marijo Bilusic, Professor of clinical medicine and genitourinary medical oncologist

“The consistency and robustness of this result was very exciting. It raises the possibility that Lac-Phe could be a molecular hub for general metabolic benefit from insulin-sensitizing drugs.”

— Priyamvada Rai, Professor of radiation oncology and co-leader of Tumor Biology program

What’s next

Researchers are evaluating the impact metformin may have on improving treatment success for prostate cancer patients by normalizing their metabolic profile, as obesity, inflammation and high lactate can prevent immune cells from recognizing cancer.

The takeaway

This research suggests the common diabetes drug metformin could help address the metabolic issues that often arise in prostate cancer patients on hormone therapy, potentially improving their quality of life and treatment outcomes. The discovery that metformin can mimic the metabolic benefits of exercise is an exciting development.