Low testosterone & lymphnodal invasion.

[pjoshea13]

New Italian study below, [1].

Yet another study that associated low testosterone [T] with more aggressive disease.

"In clinical PCa, the risk of {multiple pelvic lymph node metastasis} was increased by low {endogenous testosterone} levels. As {endogenous testosterone} decreased, patients had an increased likelihood of {multiple pelvic lymph node metastasis}. Because of the inverse association between {endogenous testosterone} and {multiple pelvic lymph node metastasis}, higher {endogenous testosterone} levels were protective against aggressive disease."

Late in the last century, Patrick Walsh at Johns Hopkins discovered that a year after prostatectomy, T levels had increased. The conclusion being that cancer in the prostate was able to influence T production. [2]

This study was reproduced in Australia & somewhere else.

And in this Greek study [3]:

"In the group of 66 patients {who did not have biochemical recurrence} there was a statistically significant increase in serum TST, LH and FSH, and statistically significant decrease in serum DHT ..."

A Swedish study [4], only 90 days post-RP reported:

"There were 53% increase in serum LH, 21% increase in serum FSH, and 13% decrease in DHT levels" - but no increase in T.

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/342...

nt Urol Nephrol

. 2021 Jul 6. doi: 10.1007/s11255-021-02938-z. Online ahead of print.

Low endogenous testosterone levels are associated with the extend of lymphnodal invasion at radical prostatectomy and extended pelvic lymph node dissection

Antonio Benito Porcaro # 1 , Clara Cerrato # 2 , Alessandro Tafuri # 3 4 , Alberto Bianchi 2 , Sebastian Gallina 2 , Rossella Orlando 2 , Nelia Amigoni 2 , Riccardo Rizzetto 2 , Alessandra Gozzo 2 , Filippo Migliorini 2 , Stefano Zecchini Antoniolli 2 , Carmelo Monaco 2 , Matteo Brunelli 5 , Maria Angela Cerruto 2 , Alessandro Antonelli 2

Affiliations expand

PMID: 34228260 DOI: 10.1007/s11255-021-02938-z

Abstract

Objective: To investigate clinical factors associated to lymphnodal metastasis load in patients who underwent to radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND).

Materials and methods: Between November 2014 and December 2019, ET was measured in 617 consecutive patients not under androgen deprivation therapy who underwent RP and ePLND. Lymphnode invasion (LNI) was codified as not present (N = 0) or with one (N = 1) or more than one metastatic node (N > 1). The risk of multiple pelvic lymph node metastasis (N > 1, mPLNM) was assessed by comparing it to the other two groups (N > 1 vs. N = 0 and N > 1 vs. N = 1). Then, we assessed the association between ET and lymphnode invasion for standard predictors, such as PSA, percentage of biopsy positive cores (BPC), tumor stage greater than 1 (cT > 1) and tumor grade group greater than two (ISUP > 2).

Results: Overall, LNI was detected in 70 patients (11.3%) of whom 39 (6.3%) with N = 1 and 31 (5%) with N > 1. On multivariate analysis, ET was inversely associated with the risk of N > 1 when compared to both N = 0 (odds ratio, OR 0.997; CI 0.994-1; p = 0.027) as well as with N = 1 cases (OR 0.994; 95% CI 0.989-1.000; p = 0.015).

Conclusions: In clinical PCa, the risk of mPLNM was increased by low ET levels. As ET decreased, patients had an increased likelihood of mPLNM. Because of the inverse association between ET and mPLNM, higher ET levels were protective against aggressive disease. The influence of locally advanced PCa with high metastatic load on ET levels needs to be explored by controlled trials.

Keywords: Endogenous testosterone; Extended lymph node dissection; Locally advanced prostate cancer; Lymph node metastases; Prostate cancer; Radical prostatectomy.

[2] pubmed.ncbi.nlm.nih.gov/967...

[3] pubmed.ncbi.nlm.nih.gov/174...

[4] pubmed.ncbi.nlm.nih.gov/197...

[Garp41]

Could low T just be a marker for old age?

[LearnAll in reply to Garp41]

No. Garp. I know many men who are 65-70 years old with total T ranging 500 to 900. Below 300 is considered T Deficiency.

[cesces]

Do we learn anything from this study that we, as patients, can put to use?

[Spyder54 in reply to cesces]

Cesces. See my question below?

[lcfcpolo]

Hi Patrick. If my T was actually low at diagnosis, even though PSA and metastasied was high, is this an indicator that BAT maybe of benefit or any other treatment. Thank you. Graham

[pjoshea13 in reply to lcfcpolo]

Graham,

I have used testosterone [T] for 16 years and my latest blood results show that I am still androgen-sensitive. There are many ways to incorporate T into androgen receptor axis treatments [ARAT}. The primary purpose IMO is to shock tumors that are adapting, back to an earlier state. Otherwise, CRPC will occur for most in a fairly short period of time.

I think it is useful for you to become familiar with Samuel Denmeade's BAT protocol, but when I tried his 28-day cycle, I found it to be unbalanced. I have settled on 200 mg T cypionate injected on day 1 of 60 (i,e. a 2-month cycle). Denmeade uses 400 mg to try to induce double-strand breaks, but this is something one can save for later, if so inclined.

Test PSA on day 60 and plot the 2-monthly values. As long as the trend is not upward, the approach is working. Otherwise, try a 90-day cycle before giving up.

Work with a doctor who is sympathetic to the approach & can work with you.

Best, -Patrick

[lcfcpolo in reply to pjoshea13]

Thank you so much Patrick. Really appreciated. Now to find a UK doctor..

[GreenStreet in reply to lcfcpolo]

If you find one could you let me know. My oncologist reacted with incredulity horror about the idea of something so experimental. I am UK based.

[Currumpaw]

Hey pjoshea13!

A good find! Sort of supports BAT.

Currumpaw

[Spyder54]

Thanks Patrick,“The influence of locally advanced PCa with high metastatic load on ET levels needs to be explored by controlled trials.” I assume ET stands for Elevated Testosterone? This makes me think (as I have multiple enlarged lymph nodes in the pelvic region) that the guys here on HU going thru BAT may be getting 2 birds with 1 stone. Not only are they extending the timeframe for Castration Resistence, they may be substantially lowering there risk of lymph node involvement, or extension if already present. Yes?

Thanks,

Mike

St Pete

[pjoshea13 in reply to Spyder54]

Mike.

ET in the study simply means "endogenous" T. Which I take to mean serum T.

-Patrick