Post ADT Testosterone replacement therapy

[tsim]

I am interested if anyone has undergone testosterone replacement after ADT. Some new studies have suggested low T after ADT can actually accelerate cancer progression..

[AlmostnoHope]

NO WAY.

[Tall_Allen]

You are confusing that men with naturally low testosterone (called hypogonadal) have higher incidence of prostate cancer. This is not at all the same as saying that TRT after ADT for prostate cancer is a good idea. There is an experimental therapy called "bipolar androgen therapy (BAT)" where ADT is alternated with TRT - but that should not be attempted outside of a carefully watched clinical trial - it can accelerate progression.

[tsim in reply to Tall_Allen]

Sorry for the confusion, I should have been more specific in my question. .I am familiar with naturally low T replacement and have done extensive research on BAT therapy, even saw Dr. Sam Denmeade speak once. I was speaking of testosterone replacement over multivariate groups of previously treated PcA patients. The pioneer for this appears to be Dr. Abe Morgenthaler, the Harvard urologist. Can you please review these articles and studies at your leisure and let me know what you think? Still controversial, but I feel I would be a good candidate. Thx, TS

renalandurologynews.com/hom...

ncbi.nlm.nih.gov/pubmed/260...

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pubmed/171...

medscape.com/viewarticle/91...

medscape.com/viewarticle/91...

ascopost.com/News/59851

[Tall_Allen in reply to tsim]

I am familiar with Morgenthaler's work - none of that appears to apply to your case. He doesn't deal with men taking ADT for advanced PC.

[tsim in reply to Tall_Allen]

Actally, I believe it does. I'm not on ADT , only locally advanced N0M0,.G7, long term, very slow growth PC.(3 Oncs agree with me on this) PSA is currently undetectable at 24 months of a truncated 18 month ADT cycle. .

[Tall_Allen in reply to tsim]

I don't understand - are you saying that the only therapy you've had so far is ADT? No RP? No RT? ADT without RT is not likely to rid you of your cancer. There was even a clinical trial that demonstrated this. Why would you then take testosterone to undo whatever good ADT did for you?

[tsim in reply to Tall_Allen]

I apologize, probably should have filled in my profile a bit more, had brachy HDR, two 11.5 Gy treatments, 25 1.8 Gy IMRT sessions. This is what Lupron and no testosterone does to you. This last year, people looked at me and said "what were you going to do" and for the first time in my life I said I don't know.

[Tall_Allen in reply to tsim]

OK - that makes a little more sense. Yes, it helps if you fill out a profile with your diagnosis and treatments so far. And in what way was your prostate cancer "locally advanced"? - had it spread to your bladder or rectum? Also, when you said Gleason 7, you mean 4+3, right?

So, 6 months after the end of your 18-month adjuvant ADT, your testosterone is still low. What is it? It can take a year to recover naturally. Does it seem to be recovering? I had low T for a year after my SBRT treatment, and know how eager I was to get it back. It did come back to normal for several years, but then declined again as I aged. So, 8 years post therapy, I decided to use TRT.

[tsim in reply to Tall_Allen]

I had a small (approx 1.3 cm) tumor in left SV, slight perineural involvement, Gleason was 3+4. No bladder or rectal involvement. No other detectable mets. T was at 3 throughout ADT, rose to 10 and now at 17. Have a lab coming up in December. I am getting some strength and memory and cognitive function back but very slowly. What did your recovery curve look like? I guess I'd rather take my chances, I'm 67 so waiting 8 years is not an option.

[Tall_Allen in reply to tsim]

It's just terminology, but that is not called "locally advanced," that's called "high risk." I guess because of the brachy boost, you (reasonably) felt that 18 months of ADT was enough.

I never took ADT, but sometimes T levels get temporarily depressed after radiation. After a year, my T levels, which got down as low as about 150 ng/dl, got back to around 500 ng/dl.

The critical thing that us radiation guys have to consider is that T can interfere with PSA readings, and we need PSA to tell us if the radiation worked. So let's say, for example, that after TRT, your PSA goes to 2.0 ng/ml - is that a biochemical recurrence, or is that just T causing BPH? Because this is so soon after treatment, even a biopsy can't tell you (there are still cancer cells that are present, although they may or may not be functionally dead). I'm sympathetic, but I think you have to let your T come back naturally first and see what your PSA does first before trying TRT.

[tsim in reply to Tall_Allen]

OK, thanks, I'll try and give it some more time.

[JWS13 in reply to Tall_Allen]

Allen, Are you saying that TRT after ADT is a good idea , (if natural testosterone has not rebounded or come back and essensially low (80) ...)

[Tall_Allen in reply to JWS13]

I just replied to you. I said exactly what I meant to say.

[tsim in reply to Tall_Allen]

BTW, thanks for that initial advice allowing my T to return normally. It took about a year and a half but came back higher than it had been in 20 years!

[JWS13 in reply to tsim]

tsim , could you please reply with the sequence of timing that your t came back..i.e. How long were you on adt? (lupron or Orgovyx? )..how many months after you finished your adt did your t come back and what number? TIA Jeff

[tsim in reply to JWS13]

I was on Lupron depot for 18 months. Prior to that, at my diagnosis my T was at 330 or so and went down to basically zero. Three months after the last Lupron injection it started to rise slowly but was a bit behind the normal recovery curves (you can search for this data online) After approx. six months it was over 100 but still lagging and I was getting a bit impatient. That's when TA suggested I wait it out a while and let it recover naturally. At the nine month interval it was in the slightly under three hundred, twelve month was in the high three hundreds and the next two readings progressed up to five hundred eighty eight. The recovery curves also suggested the most I could expect was in the three hundreds. If it stalls out at a lower number you can speak with your oncologist about possible replacement therapy.

[JWS13 in reply to Tall_Allen]

Allen, did i say something wrong?? I am only trying to get info and/or resources. Allen if there is a problem with my questions...let me know..I am a retired Judge and I would think I know how to "read the room" ..thanks

[Tall_Allen in reply to JWS13]

I don't want anyone misinterpreting my words. What I said was exactly what I meant to say.

[JWS13 in reply to Tall_Allen]

I never intended to misrepresent your words . Which post was the post that "you said exactly what I meant to say " so I can get an idea what you are referring to . Where was the "transposition"?

I am sorry you read "something" into my statement but either I didn't understand or?? but I had absolutely no intent to change anything that you posted.

You are a gift to this community with your informed answers and total wealth of knowledge on this subject. In addition , your desire and willingness to freely share your knowledge is truly commendable..

Notwithstanding , I am not going to waste anymore time on this particular thread. .. I have cancer to deal with..and so do you... thanks

[Tall_Allen in reply to JWS13]

You wrote:

"Allen, Are you saying that TRT after ADT is a good idea , (if natural testosterone has not rebounded or come back and essensially low (80) ...)"

I said nothing of the kind. What I said is written above.

[GP24]

A friend of mine does intermittent ADT and to raise testosterone quickly when starting with an ADT holiday, he uses Toremifene citrate. I never used it and cannot recommend it, it is used by bodybuilders.

[tsim in reply to GP24]

Interesting, that's an estrogen suppressor like tamoxifen. Does he take it right at the time he's trying to raise testosterone levels and what are the differences?

[GP24 in reply to tsim]

He did not tell me. If you got a 3-month Lupron shot I would wait an additional six weeks for the Lupron to clear and then use Toremifene. My friend prefers Toremifene and mentions that it is more expensive than Tamoxifen. I read that Tamoxifen will also increase the testosterone level.

I took Bicalutamide and Tamoxifen for a while and my testosterone level was twice as high as it should be for a healthy man.

[Hidden in reply to GP24]

Bicalutamide blocks T from getting to the ARs. Your T should increase 80% or thereabouts.

[GP24 in reply to Hidden]

Twice as high is a 100% increase. I also observed that over time T got a bit reduced. So I agree with 80% or thereabouts.

[Hidden in reply to GP24]

On average bicalutamide increases tT by about 80%. It increased mine by about 90% when I used it. Maybe the Tam also increased it some. I was using Tam for a while but my MO asked me to stop.

But most of the T is useless. You do have a lot of T floating around though so dutasteride might be indicated (my MO and I did a bicalutamide and dutasteride therapy for about a month - I moved on rather prematurely to try high testosterone).

[BerkshireBear]

I had low T before the Dx of PCa - another condition that has been fingered as favouring the development of PCa. I was not put on ADT, rather placed on TRT during my external beam radiation (IGRT) and have been on it for the 15 years since. I suggest you seek the research done by Morgentaler at Harvard Med. grandroundsinurology.com/te... etc.

[tsim in reply to BerkshireBear]

Thank you for the reply. I have done extensive research on Dr. Morganthalers theories and body of work. I'm guessing that your PcA was fully contained within the prostate? Not sure how much longer I'm willing to go with such low testosterone after ADT.

[Hidden in reply to tsim]

When we do ADT we mess with our hormones with drugs or surgery.

I simply do not understand the logic of waiting an indeterminate amount of time to get your T back to normal. Mine recovered in a few weeks. Most guys take months or even years.

Androgel or cypionate in low doses will get it back in hours.

High doses IF you are doing BAT or high testosterone (SPT). I did estrogen-ADT for 5 months, bicalutamide/dutasteride for 1 month, SPT for two years and now I am doing BAT. I was an SPT hyper responder but it only lasted 2 years before I bailed. I'm in the 8th month of a modified BAT program and so far it is keeping my PSA to undetectable levels. It doesn't work for everyone though so needs to be carefully monitored (my MO watches it with me and even when I worry about it she tells me that it is working great and to keep on keeping on).

[Radars in reply to Hidden]

can anyone help my situation regarding trt ,I have locally advanced prostate cancer t3b no mo seminal vessicles involved, dx 2014 finished treatment 2016,my testosterone has not recovered, I have asked for some test but no,it's not good with no testosterone I am only 8st and now I have been dx with osteoporosis I am a walking skeleton, I am supposed to be having zoledronic acid infusion on the 25th of this month, but after reading horror stories regarding side effects, I also have chronic dry eyes all this because of no testosterone, any help please.

[JWS13 in reply to Radars]

post as a regular post and you will get replies