Testosterone gradually going down while PSA gradually going up (I'm not currently on any treatment)

[Terry33]

Hello folks! I checked my blood results today (and I have an appointment next week with the oncologist to discuss them.) Basically, I had an RP in the summer of 2019 with a Gleason of 4 + 3. I had follow-up radiation and hormone therapy for 9 months. Both testosterone and PSA went to and stayed undetectable. I then stopped all treatments. In January 2021, testosterone gradually recovered to mid-range normal levels and PSA was initially undetectable and then later very tiny with a very slow rising trend. In the last 9 months or so, the testosterone has gradually been going down (it's still within normal, though), while the PSA has been gradually rising (currently less than 0.1). I know what rising PSA generally means, but coupled with the decline in testosterone? Does it mean I'm becoming hormone-independent? Castrate resistant? What do you think? What options? I'd like to have some of your valuable information and opinions going into next week's appointment. Please and thank you.

[Tall_Allen]

Castration resistance is only when testosterone is at castrate level (<50 ng/dl), not when it is normal.

[Terry33 in reply to Tall_Allen]

Thank you Allen for clarifying that.

[Qrak in reply to Tall_Allen]

What about estradiol levels ? How do they relate to PSA and T levels ? Would a rise in PSA combined with a drop in testosterone automatically cause/ indicate a rise in estradiol ?

[Tall_Allen in reply to Qrak]

Natural estradiol levels increase when testosterone increases. It is a metabolite of testosterone.

[Qrak in reply to Tall_Allen]

My last BT shows PSA 0.019, T 9.78 ( range 6.68-25.7 ), estradiol 201 ( range 41.4-159 ). This was the first time I tested for estradiol. Testosterone actually dropped from 11.40. Should I be looking for something there ?

[Tall_Allen in reply to Qrak]

Estradiol goes up with androgen receptor blocker monotherapy (e.g., Casodex) because the testosterone has nowhere to go and accumulates, causing excess estrogen. That's why it caused gynecomastia.

IDK why your E2 increased.

[Qrak in reply to Tall_Allen]

Thank you for your answers.

[London441]

Testosterone fluctuates a lot. If it’s still in normal range it probably means nothing. Try to get tested at roughly the same time of day each visit.

[Terry33 in reply to London441]

Thanks for the tip, I'll do that from now on.