Testosterone - How low can it go?

[rsgdmd]

Briefly, diagnosed in April with de novo high volume metastatic PC. Plan was to follow PEACE-1: Lupron, abiraterone & 6 rounds of docetaxel. Had to stop abiraterone first for irreg. heartbeat & then right before starting chemo as bilirubin went way up. Since chemo is hard on the liver, abiraterone is on hold til done chemo. Had testosterone checked one week after my last chemo and was <2.5 ng/dL.

I know abiraterone blocks testosterone from the adrenals, but how much lower could I be if I was taking it? Since I'm so low, would I be getting much advantage if I could take it?

[d3is4me]

I think Firmagon would be better for you heart than Lupron, others with more knowledge should comment

[Islandboy2021]

I was started on Zoladex then the 6 rounds of Chemo and radiation to the prostate. My testosterone went to 0 and has been there for almost 5 years with only single ADT. Will probably start Abiraterone soon as my PSA has started climbing.

[addicted2cycling]

7 years since my bilateral Orchiectomy lowest numbers given by my testing results simply labelled T < 2.5ng/dL

[Tall_Allen]

You are mistaking PSA for your cancer. It isn't. Low PSA is better than high PSA, but a lot is going on biologically that is not reflected in PSA.

Some patients, who initially, have a liver reaction to abiraterone, respond better if the dose is slowly increased. Alternatively, you can try switching to darolutamide (Nubeqa) instead. It's important that you take one of them early.

[d3is4me in reply to Tall_Allen]

T_A If PSA is not cancer[and I agree] What is the best indication for progression or receding PC

[Tall_Allen in reply to d3is4me]

Scans of various types.

[d3is4me in reply to Tall_Allen]

T_A Thanks

[d3is4me in reply to d3is4me]

T_A Why do doctors in Australia treat PSA as the "Holy Grail" as PC diagnosis is it the cost I had to fight to get my last scan and had to pay full price [self funded in AU]

[Benkaymel in reply to d3is4me]

MRI screening for all men over a certain age would greatly reduce the numbers Dx'd with APCa but I guess it's too expensive, however, is the cost of treating all these cases even higher?

[rsgdmd]

Maybe I wasn't clear with my question. My Testosterone is <2.5 on Lupron alone. Had to stop abiraterone due to liver issue as chemo was to commence. Wondering if I was on abiraterone if my testosterone could be even lower and how significant a difference it is between <2.5 and O?

[Tall_Allen in reply to rsgdmd]

Your question was clear. You are not understanding the answer, because you think you understand how cancer behaves. We know how it responds because of clinical trials.

[Kevinski65 in reply to Tall_Allen]

Anyway you could summarize what is happening. Doctor's say all is good when my PSA is low like .04. They won't do scans, or anything else under Medicare. I bitched about the bone density test and got nowhere. The other day I got cavities filled , revealed that and he said no Zometa today. I usually get it every 3 months.

[London441 in reply to rsgdmd]

The abiraterone fights disease as a mechanism of its action regardless of the degree it helps drive down testosterone. It might lower it further than Lupron alone or it might not, which is irrelevant.

[rsgdmd in reply to London441]

Ok, that's the answer I was after. So, cutting out the testosterone from the adrenals is only part of the action of abiraterone. Seems like I need to do more homework on 2nd generation drugs.

[dhccpa in reply to London441]

Quite frankly, I didn't know that. I thought it (and all ADT) worked solely through T reduction.

[Turt713171 in reply to dhccpa]

Works at tumor site also

[dhccpa in reply to Turt713171]

Thanks didn't realize that.

[hopefull99 in reply to rsgdmd]

I was diagnosed with metastasized PC and have ben on Zytiga and Lupron for a couple of months.

PSA has dropped to 1.1 and testosterone < 0.45. Handling meds OK.

My doc wants to easy off from Lupron and use it only if testosterone increases rather than every 3 month schedule.

He is happy if my PSA stays below 3 to 4 and Testosterone below 35.

[Seasid in reply to hopefull99]

Can you change doctor? Can you transfer yourself to a medical oncologist?

[hopefull99 in reply to Seasid]

I suppose I can always change doctors... Current doctor is a medical oncologist

Any particular reason for your suggestion?

[Seasid in reply to hopefull99]

that is good that you have a MO. My last PSA is just under 1 after 4 years on Firmagon injections alone and I would not be happy if my PSA would go up. Of course psa between 3 and 4 is better than above 4.

Where do you treat yourself? You could get a second opinion about your treatment (maybe your treatment is reasonable) before changing oncologist. I am not a doctor just didn't understand why is PSA between 3 and 4 reasonable?

[hopefull99 in reply to Seasid]

Thanks for your feedback

I am in San Diego area.

My last PSA test was 2.2, up from 1.1 the month before. My MO was not very happy about it ... he is considering changing meds if the next PSA test is not good. The PSA 2.2 value being of concern and his prior statement that PSA of 3 to 4 is acceptable is not making sense, but I understand that things are not always black and white.

I may be changing meds to XTANDI from ZYTIGA and prednisone ,, which is fine with me as I am not happy with prednisone side effects.

At any rate this blog is very helpfull in itself and for providing direction for further research

[Seasid in reply to hopefull99]

I am afraid of the side effects of Zytiga plus Prednisone as my blood pressure sometime goes up and up. It is possible to control but I wouldn't be happy (i would be scared) if I would see Blood pressure going up even further up then it is going up now.

Sometimes it takes more than a day to control it properly if I neglect something. Like consuming too much salt or not exercising enough or just simply not taking the full dose of my medication. Etc.

[Seasid in reply to hopefull99]

Can you change to monthly Firmagon injections? Actually i am getting Degarelix (Firmagon every 4 weeks always at 8.20 am as it is easier for me to remember).

[Shooter1]

You won't see zero.... <2.5=====less than 2.5 which is the sensitivity limit for the test....

[Hidden in reply to Shooter1]

Shooter, so if testosterone goes up a little but PSA is going down this is not good… we should also be watching the T very closely. Thank you for your reply!

[rsgdmd]

I guess I'm not asking this right. With Testosterone at <2.5, would I really be getting any benefit if I was also on abiraterone (in addition to the Lupron)?

[Tall_Allen in reply to rsgdmd]

PSA is not cancer. You are mistaking a biomarker for your cancer.

[addicted2cycling in reply to rsgdmd]

rsgdmd wrote --- " I guess I'm not asking this right. With Testosterone at <2.5, would I really be getting any benefit if I was also on abiraterone (in addition to the Lupron)? "

Shooter1 WROTE -- "You won't see zero.... <2.5=====less than 2.5 which is the sensitivity limit for the test...."

^^^^^ What Shooter1 replied. Most likely your testing facility DOES NOT HAVE A LOWER THAN 2.5 result that can be posted. Use a different LAB.

I have no testicles and the *T* from Adrenals is taken away BUT MY LAB only shows T < 2.5ng/dL because that is their lowest number.

[Hidden in reply to rsgdmd]

This is the decision we are struggling with, as well!

[tallguy2]

Using Xgeva I get T immeasurably low.

[rsgdmd]

Isn't Xgeva for osteoporosis?

[Ianrs]

Zolodox (3-monthly injections) and Xtandi (120 daily) started 12 months ago with radiation 6 * 6 last October, for last 9 months both testosterone and PSA (<0.03) unmeasurable. I follow the advice of my oncologists and do not try to second guess them. If that means I must continue with hormone treatment so be it; it's side effects are better than the alternative.

[Guber]

Could someone answer the original question?

[Kevinski65]

Stay on lupron whatever the case. It does the heavy lifting.