Why no testosterone monitoring?

[tdelpozz]

I had my first psa test at age 56 in 2006 and it was 30 or so. From then until last October psa levels remained high and had 2 biopsies which were clear, and high psa attributed to BPH. In October 2019 had HOLEP surgery to reduce prostate size and biopsy of removed prostate material revealed cancer with 9 Gleason. After several scans diagnosed with metastasis in some bones and lymph nodes. Being treated now with bicalutamide and eligard. I have had a couple labs and so far testosterone levels have not been included and I would think that would be a standard item monitored. Any thoughts? Thank you!

[Tall_Allen]

You can ask for it. Ideally, it should be below 20 ng/dl. More importantly, why only Eligard? Lots of evidence now that adding Zytiga, Xtandi, Erleada or Taxotere extends survival.

prostatecancer.news/2017/06...

[tdelpozz in reply to Tall_Allen]

My doc mentioned that early on but hasn't brought it up again. Maybe waiting for later if needed?Also I believe they were pretty pricey. Thanks for the info!

[Tall_Allen in reply to tdelpozz]

They are all a LOT more effective if used earlier. Maybe your doc is waiting for you to bring it up - like the testosterone level. The only things you have control over with this shitshow of a disease are the decisions you make.

[tdelpozz in reply to Tall_Allen]

You are right!

[pskp00 in reply to Tall_Allen]

Wondering what is done if testosterone goal of <20 is not achieved while on ADT meds?

[Tall_Allen in reply to pskp00]

Castration is defined as below 50. Below 20 is ideal. What is yours?

[tdelpozz in reply to Tall_Allen]

Haven't had it checked yet. Next lab is in couple months.

[Magnus1964]

I would definitely ask for testosterone level to be included with labs.

[Hidden]

The drugs are very reliable at reducing your testosterone, but at least check it initially to make sure you are castrate, ideally below 20.

After that, periodic checks are probably a good idea. If you have really good PSA response that's the bottom line so to say. You certainly want to check it if it's looks like you are becoming castrate resistant.

[tdelpozz in reply to Hidden]

Thanks!

[pjoshea13]

Yes, testosterone [T] is standard. However, some argue that free T is more relevant [1]:

"Free testosterone

"Perhaps, one of the most important yet understudied questions in helping to define the clinically desirable castration of men with advanced PCa is what form of testosterone should be measured. As described above, total testosterone is what is principally used today, but free testosterone is the biologically active form and therefore is also termed bioavailable testosterone. Perhaps, free testosterone would be a more clinically and biologically relevant measure of castration than total testosterone. Free testosterone has been demonstrated to be an important biomarker for cancer-specific survival in PCa; cancer-specific survival is longer for patients with a free testosterone level below the cutoff, almost 26 months longer than the group with free testosterone above the cutoff.[24] Bioavailable testosterone (including free testosterone) may correlate better with symptoms than total testosterone.

"Only 2% of all testosterone in the body is unbound and free. According to the free hormone hypothesis, only the 2% of testosterone which is free can diffuse into cells and bind to the AR.[25] As free testosterone is the biologically active form of testosterone, it should be given more attention in the treatment of PCa.

"A cross-sectional study evaluating assays which measure free testosterone, the goal of which was to determine the concordance of the various assays to one another, was conducted on fifty males.[26] This study demonstrated that there was a significant correlation among the free testosterone index, free testosterone by EqD, and bioavailable testosterone. The free testosterone value was calculated by the Vermeulen method, a formula relying on the total testosterone and SHBG values obtained from immunoassay.[27] This approach is a practical measure of bioavailable testosterone as a result of its simplicity and efficiency in detecting hypogonadism.[26]

"Patients with advanced PCa that achieve lower free testosterone levels have been shown to have overall better survival rates.[5] Despite these findings, more studies need to be conducted examining the levels of serum free testosterone and determining any correlations with PCa disease progression. A study published in Oncology Letters examining a group of 34 patients illustrated that the mean free testosterone was a significant prognostic factor of cancer-specific survival; also, cancer-specific survival (43.6 vs 17.3 months, P = 0.0063) was statistically significantly longer in patients with free testosterone levels below the cutoff level than patients above it.[24] Thus, suppressing biologically active testosterone (free testosterone) would appear to be a primary goal of ADT.

"There is sparsity of data or even mention of free testosterone and desired castrate levels in regulatory or federal guidelines. Thus, more research needs to be conducted, perhaps comparing total and free testosterone levels within a population undergoing ADT in which clinical outcomes are determined. In the next section, a few such studies are described."

***

Dr. Myers has argued that the ultimate aim of ADT is to deprive PCa of dihydrotestosterone [DHT]. Some men with castrate T produce high levels of DHT.

-Patrick

[1] ajandrology.com/preprintart...

[tdelpozz]

Thanks Patrick!

[j-o-h-n]

Ask to include in tests.... if doc says no... surprise him with the standard response..... When he turns around DRE him as is.... (fully dressed).... No need for a rubber glove....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 07/09/2020 5:49 PM DST

[tdelpozz in reply to j-o-h-n]

Great advice John! But thankfully they agreed!

[Seasid in reply to tdelpozz]

Chemotherapy is not pricey. I think cost only 100 dollars per cycle. You need 6 cycles. You can add abiraterone and prednisol if you like.