5 alpha reductase inhibitors, DHT, and uPSA

[LowT]

Would like to hear thoughts regarding the use 5 alpha Reductase Inhibitor in a 79-year-old PCa; status post RRP 2016, GS 3+4=7; +EPE, neg #24 PLND, who over the last 15 months is exhibiting a slow rising uPSA. This has not reached 0.050 but has reached 0.030 and trending upward.

Reason for this consideration is an attempt to ward off a true future BCR, should that occur, and decision regarding SR, ADT, etc. along with avoiding potential of SEs and maintaining QOL. The goal would be to delay a future BCR, should that occur, without negatively impacting clinical course or ultimate outcome(s).

A 3-week trial of dutasteride resulted in a 90% drop in DHT and a 50% drop of uPSA, both of which rose again over a several month period as the 5aRI was slowly cleared by the body.

Reducing DHT levels would lessen its effect on cancer cells if present, (being reflected by lower by uPSA) and potential of delaying advancement of any cancerous cells. Don’t see any downside to this other than cost and the potential of “masking” an earlier detectible BCR via PSA.

In this age group it would seem chances of other health issues arising would occur before a recurrence of PCa, if that should occur.

[Tall_Allen]

The downside, and it is a big one, is treating the PSA without treating the cancer.

[LowT]

Thanks for the detailed response. It is pretty much what my thoughts have been but being a newbie I wanted to seek out knowledge of those further along the path.

I understand this is not treating cancer, but should some cells "be in a state of senescence", it seems reasonable to prolong their peaceful sleep with use of such things as diet, exercise, supplements, etc., and possibly 5aRI if there would not be a significant downside.

I know there are no studies out there that specifically address my question but would be interested in hearing your educated guess from years of experience about prolonging or setting back the alarm clock of the possibility of "waking up" the beast, should that be in the future? And what could be potential downside(s) that might off-set the benefit of such an action in the setting of this age group?

Thanks again. Your thoughts are extremely helpful.

[MateoBeach in reply to LowT]

Since you have +EPE implying cancer extension locally you would want to consider early SRT. So I would use the criteria Nalacrats detailed, 3 successive rises even if still well below 0.20. Would not want this masked by 3aRI at time of decision for this which could still be curative.

[LowT in reply to MateoBeach]

Yes, that is the question! Don't want to go too early or too late (I am 3 1/2 years). And in the long run it may not be necessary given my age of 79 and not having good data regarding the possibility that this will or will not progress (assuming it's coming from cancerous cells). SRT does not come without its SE.

My surgery was complicated by one-week hospitalization due to severe intra-abdominal blood loss as a result of the RRP and extensive PLND #24 (all negative thankfully) requiring 2 units of blood transfusion. I suspect there is a lot of scaring in the pelvis as a result of all this and what would SRT do to further this because of bilateral lymphedema present since this surgery, pretty much controlled with support hose but initially quite significant. Also constipation since surgery. If these worsen, QOL would suffer for sure and in the end it may not be needed.

Another issue I have been dealing with is Late Onset Hypogonadism and osteopenia.

Otherwise I've quite healthy!! LOL, that doesn't sound quite right does it?

Just glad they were making good models back in 1941.