Ivermectin, Mebendazole, Metformin, High-Dose Vitamin C, Vitamin D, Curcumin, Diet/Lifestyle, and Standard Therapies for Non-BRCA-Mutated Stage 4 Prostate Cancer: A Simulated Double-Blind Randomized Controlled Trial

Abstract Background: Stage 4 prostate cancer has a 5-year survival rate of ~34% with standard of care (SOC, e.g., androgen deprivation therapy [ADT], chemotherapy, Lu-177-PSMA-617). An optimized intervention combining repurposed drugs, supplements, diet/lifestyle, and SOC components may improve outcomes. Methods: We simulated a double-blind RCT with 10,000 patients (5,000 per arm) with non-BRCA-mutated stage 4 prostate cancer (70% mHSPC, 30% mCRPC), comparing an intervention arm (ivermectin 1.5–2 mg/kg/day 3 days/week, mebendazole 500–1,500 mg/day, metformin 1,700 mg/day, vitamin C 1 g/kg IV 3 times/week, vitamin D 5,000 IU/day, curcumin 1,000 mg/day, low-glycemic Mediterranean diet, exercise, MBSR, plus ADT/Lu-177-PSMA-617) to a placebo arm with SOC. Primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS), quality of life (QoL, EORTC QLQ-C30/PR25), PSA response (≥50% reduction), time to PSA progression, PSA nadir, and safety. A Monte Ca...