Post ADT Testosterone replacement the... - Advanced Prostate...

Advanced Prostate Cancer
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Post ADT Testosterone replacement therapy

tsim
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..

16 Replies
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NO WAY.

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
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
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
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
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
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
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
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
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
tsim in reply to Tall_Allen

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

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
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
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.

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
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.

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