Two cheap medicines, a cholesterol drug and one first sold for erectile dysfunction, each cut a tumor cell's cholesterol supply at a different point, and blocking both did more in animals. No human study of the pair exists. Each carries a well-established benefit unrelated to the tumor. Safety is well understood; benefit against cancer is unproven. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Total cholesterol | 160–200 mg/dL | Confirms the statin is working and flags over-depletion |
| LDL-C | 60–100 mg/dL; below 70 mg/dL with cardiovascular disease | Primary measure of statin effect and proxy for exposure |
| ApoB | Below 80 mg/dL; below 60 mg/dL at high risk | Tracks particle number, a better risk predictor than cholesterol mass |
| CK | Below 200 U/L, and below twice the upper limit of normal | The most important safety marker for the statin partner |
| ALT and AST | Below 25 U/L in men, below 20 U/L in women | Detects hepatic injury from the statin or chemotherapy |
| HbA1c | Below 5.4% | Detects the statin-associated glucose rise before diabetes |
| eGFR | Above 90 mL/min/1.73 m² | Sets the safe rosuvastatin dose; flags rhabdomyolysis kidney injury |
| hs-CRP | Below 1.0 mg/L | Tracks the statin's anti-inflammatory effect, partly independent of cholesterol lowering |
| Coenzyme Q10 | 0.8–1.2 µg/mL | Identifies the depletion proposed to underlie statin muscle symptoms |
| Testosterone, total | 500–900 ng/dL in men | Cholesterol is the substrate for steroid hormone synthesis; low testosterone is common here |
| Blood pressure, seated and standing | Above 100/60 mmHg seated; under 20 mmHg systolic drop on standing | Detects orthostatic hypotension limiting PDE5 inhibitor dose escalation |
Cadence: Fasting baseline panel before the first dose, including the one-off genetic test. Lipid, liver and muscle markers at 6–12 weeks after starting or any dose increase, again at 6 months, then every 6–12 months once stable. Glycated hemoglobin annually. Creatine kinase whenever new muscle symptoms appear. Blood pressure at every dose increase.