My testosterone was reported as < 20 six months after my last Lupron shot in September 2019. Why reported as < 20, why not 18 or 5 or whatever is the actual value.
Can very low T increase bone loss and cardio-vascular risk? If things go by my experience with six months of Lupron in 2017, my T is expected to remain in castration level for the next 3 to 6 months at least. Doctor wanted me to go on ADT vacation to reduce the above mentioned risks to my health. If T is going to remain very low and low T can increase health risks, then what is the point of stopping Lupron.
If T remains in the castrate level, should PSA rising slowly be an indicator for castrate resistant cancer?
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dac500
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So far I have been on Firmagon for 3 months and Lupron for 18 months over the last 3 years and 3 months. Is that very long for hormone suppression? Added cardiovascular risk and bone loss when on Lupron, is that from Lupron or due to T suppression?
Doctors consider less than 20 testosterone as fully castrate. Its true that very low T for a long period of time does increase risk of heart disease and weaker bones.
Regualr vigorous excercise and walking , keeping cholesterol low , eating heart healthy foods mitigates this risk somewhat .
PSA is a measuring marker and indicates how much cancer cells are inside. Therefore,it is extremely important to measure PSA preferably every 2 weeks to watch speed of PSA rise while you are on Intermittent ADT.
You need a upper set point where you will restart ADT to push PSA down again.
Not to put too fine a point on it, but personally I'd say : PSA is a measuring marker that GENERALLY indicates how much cancer cells are inside.
Cancer can be growing without rising PSA, and PSA can be rising (if you still have a prostate) without necessarily indicating a significant growth of cancer.
PSA is a cancer "alarm bell" and sometimes alarms go off when they shouldn't or DON'T go off when they should. This is certainly true for many aging men before ever diagnosed (or not) on the basis of PSA movement (or non-movement), and it can remain true for at least some men during and after treatment.
One thing Bob Leibowitz said is that often the upper set point, where you will restart ADT to push PSA down again, is 1) arrived at in an arbitrary fashion, and 2) is reached in one or two PSA tests but then subsides on its own with subsequent tests. So when observing an apparent trend, one might want to be sure that trend is sustained... which can be hard to do without stress, I realize.
This was especially true when Dr. B took men w/ intact prostates off ADT and put them on high-T. Their PSAs would naturally rise, but then would often decline and level off on their own. (One thing we don't know is HOW often, because Dr. B obviously preferred talking about his successes, not his failures.)
Thanks for making it more clear by putting the word "generally"
In fact, the PSA producing cancer cells are milder version compared to the minority of LOW PSA producing cancer cells. High PSA producing cancer cells are generally more responsive to testosterone depletion.
All lupron does is to lower your T (androgen) thus ADT Androgen Deprivation Therapy, to starve any remaining aPC! IMO, If you have little to no T it’s likely still the result of previous Lupron or your body no longer makes T!!! That makes us the buffalos in the back of the heard (aka....old)!!!!
More than 8 months after my last 3mo Eligard deposit, I was still full blown castrated with T @19 when through out ADT, my T was @18. Castration is @50 according to Eligard spec’s! Add another 6 months later and I was just about crawling out with T @100. Takes a while and varies by individuals. Add to the fact that I don’t have a baseline for pre-dx, I will not know when I have (if) I’ve recovered my T. What has your PSA been doing through all these tests?!!!
Just like my T tests go less then 20, my PSA test have always been >0.1 and never 0.04 etc. that I’m told is the device used to test. They differ!!!
Yes, I have taken vitamin D 2000 x 2 daily to protect bones. ADT does / can raise your A1c and cholesterol thus effect cardiac and other bodily functions!!
I am on QoL vacation now and my Dr and I have set a benchmark of 2.0 before reacting. I believe the rate of increase has a bearing on the decision making too!! Blood work due to be performed this week!!! My nuts have been up in my stomach for wwwweeeeeeeeeekkkkkkssssss!!! So much riding on this test!!! ADT kicked the living shit out of me and is the last thing I want to consider right now!!! I mention this because some alternates to Leuprolides such as Estrogen, can be very bad for cardiac, in case you have to choose!!!
I’m not a Dr and honestly still really can’t remember shit so this is solely my opinion and experience. Hope this helps!!!
It takes several months for testosterone to recover to normal levels. Some patients never increase the testosterone from castrate levels. I am one of them, my testosterone remains at castrate level after only one 3 months lupron injection administered 3 1/2 years ago.
If your testosterone is below 20 and you had a radical prostatectomy and the PSA starts to increase in several successive measurements it could indicate the cancer is becoming castration resistant.
One three month shot three and 1/2 years ago . Wow ,lucky you . It’s crazy but might be more common than not for t not to return . Only dream I have of t someday is shots . ?? Take care
Different labs have different minimums. There's nothing to indicate that it makes much difference as long as it's below 20.
The only reason to have intermittent ADT is to give you breaks in which you feel better. If the breaks aren't long enough for T to recover, I don't see much point. Estrogen patches may mitigate bone loss (and reduce hot flashes). Switching to Firmagon may lower your risk of CV events:
My T, measured at MD Anderson, had been reported at <3 for a couple of years. My last measurement there was reported at <20. They had no good answer to my question why the change. Did their lab retire their high-quality analyzer and replace it with a crummy one? Who knows?
I’m no dr , I believe that low t like we both have does drive cv and bone loss. I’ve had 3 t for over four years now . Now osteopenia is sitting in . I’ve had two out of four six month shots of prolia. Might I suggest to you to use simple bone nutrients now and to do weight bearing exercises to help osteo issues? Be well .😎
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