Are castrate levels for T considered below 50 or below 20 ? Does it make a difference in treatment efficacy or as long as it is below 50’- any number is ok ?
Should Testesterone levels be below 5... - Advanced Prostate...
Should Testesterone levels be below 50 or below 20 ?
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Tinkudi
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Out again on your "magic" numbers hunt. Make sure that with the great help of the 2nd gen ARSI any hormone sensitive cell will be completely wipped out. Will this be good for your father or not? We will learn this in the future.
He has metastatic with distant mets - quite different than yours no ?
Are you saying ARSi should not be added ?
What would you have done in a similar situation
Check the results, NOT the "theoretically magic" numbers. Every individual is different and should be treated as such. How is his PSA moving? When is he going to have his next PSMA scan to compare with the initial one? These are things to watch after, not general statistical data which would had been useful to you if you had a thousand fathers. We only have one father each. Remember that!
Ok thanks.
Would you have done a different line of treatment if you had a high gleason score with distant mets , besides being on doublet ( or triplet ) therapy ?
When you say how psma is moving - can you elaborate a little more on that.
From your understanding what time interval is good to do repeat PSMA ?
And what is your take on this T question ? I know you said ARSi would initially raise the T but should it eventually come down ? The docs dismissed the view that ARSi would increase T
Advance as needed. Go back and find my first message to you saying: Do your father a favour and don't cause him cardiovascular problems". Initially, he had very good results with Bicalutamide. Elevate to a 2nd gen ARSI if this proved not enough. Add Orgovix if previous two steps were insufficient. Why did you leap jumped from step one to three? I wrote "PSA moving", meaning it's trajectory. Is it still going down, has it reached a nadir? That kind of stuff. PSMA scan 6 months after the initial one could be a reasonable time frame.
We will soon know for real whether T will come down. Only silly people would risk an opinion on a subject that can be test proven that easily. I am anything but silly. If you like silly people, please look elsewhere. There isn't any shortage of this type.
So initially he took bicalutamide for 3 weeks as the plan initially was to start Lupron but then we decided to go with orgovyx instead. Yes his pains had gone with bicalutamide alone but the doctors said ADT is a must so we started the orgovyx. The first psa test which I did after using the orgovyx for around 20 days ( 3 weeks bicalutamide before that ) came to 1.124. ( at diagnosis was 18 ). One MO said let us just continue with the orgovyx and redo psa in a month. So after a month the psa test came to 1.177. Now it may be that the first psa low number was also due to some effect of the prior bicalutamide ? - anyways , doctor said let us start the xtandi So we did and his last psa after being on it for 6 weeks came to 0.069
Now in retrospect I wonder if I should have given the orgovyx some more time to see if that alone bought the psa down more and was that initial low number also due to the bicalutamide - now no way of knowing that.
So that’s that for now - I appreciate your advice and hence am always happy to get it 😊
Are you saying just ARSi therapy alone may be safer and better than when added with ADT ? You don’t see T numbers as important ?
Anything measurable in the space 0.010 to 0.050 is fine with me. Further down can be promoting CR. The task isn't the number per se but staying stable with time.
Your t levels must be quite high since you don’t take ADT ? Why do doctors then focus on lower than 50 or 20 ?
Ask them, not me. My T has been supraphysiologic some years now. Latest one was "only" 1133 from 1600-1800 it hovered the year before. It didn't make me worry about how or why. My only need is to rise my PSA above 0.010 from 0.007 and 0.006 (latest 2 tests)
How did you arrive at that 0.010 number. Why does below that make cells more likely to be CR ?
Purely for practical reasons. Had to be some detectable value so that the PSA trajectory can remain evident. Among the three labs that I have confidence in only one is reporting to the 3rd decimal place. So, in doubt and need for a counter check the other two that report down to 0.01 are useless. My belief is that CR is hastened by the exertion of abusive pressure to the hormone sensitive cells. The ability to monitor their reaction to the ARSI concentration is a proof that there are some still alive and ticking. It makes sense to me more than any "must" from any oncologist that will deal with my case 15 min every 3 months.
So you think the upper limit for psa should be around 0.05 ?
T < 20ng/dL is preferred
Castration is defined as below 50, but studies have shown that lower is better, ideally below 20.
Thanks Allen . When dad was just on orgovyx his T was 26. And then after adding xtandi his T went to 41. Doc said to repeat T after two weeks , which I will be doing today.
Dad’s latest T levels today have come to 29. You think that’s ok or should I try Lupron or something else. Currently he takes orgovyx and Xtandi
Sounds good. Important to not miss Orgovyx doses, and to take full dose of Xtandi.
Ok thanks Allen. You dont think it’s better to change adt to say Lupron etc and see if T comes below 20 or below 10 ?
Allen , Can you share some links of studies which show below 20 is better
Apples to apples or apples to oranges? Are you still not convinced that ARSIs rise T?
Mean: 15.72/10.08 = 56% higher
Geometric mean: 13.83/8.43 = 64% higher
Median: 12.71/7.52= 69% higher
https://www.clinical-genitourinary-cancer.com/article/S1558-7673(23)00068-X/fulltext
😊. Ya I see the chart which is interesting but how are so many getting below 20 and below 10 T values on adt plus ARSi then ?
Come back when your father has gone through 48 weeks of treatment.
"Assessments included sustained testosterone suppression to castrate levels (<50 ng/dL) through 48 weeks and safety parameters."
Sorry I did not understand this. Can you please explain
Are you sure that 29 will be the lowest your father will test in the following months? I am not, but I am just a retired Greek engineer, so what do I know? You can put your father to Lupron and increase his chances to a cardiovascular incident. It's your father, not mine.
So usually how long does it take for T to reach nadir Mr Greek Engineer 😊
Lupron is riskier than orgovyx for cardio ?
"Retired", please!
I really don't know, but I know how to compare equal for equal.
"Relugolix was well tolerated and had a 54% lower risk of major adverse cardiovascular events relative to leuprolide.22"
I am giving you the link although I am certain you are not going to read it:
pubmed.ncbi.nlm.nih.gov/324...
You are mistaken Mr “Retired” engineer. I do read the links. 😊
So usually T shows a declining trend over weeks before reaching nadir ?
This is the definition of nadir. If it doesn't no nadir formed. We will see if it does...
What did you mean is the definition of nadir ?
Had always thought -- *Prostate-specific antigen (PSA) nadir is the lowest level of PSA after treatment for prostate cancer. It's a key factor in determining how successful treatment was and the likelihood of the cancer returning.* -- 🤔
Yeah but I am asking about the Testosterone levels 😊
K, sorry
What is the definition of a timeseries nadir?
Το ChatGPT responded
"A timeseries nadir refers to the lowest point or minimum value within a time series dataset, which represents how a certain variable or measurement changes over time. In simpler terms, it's the lowest value reached by the data over the observed period."
On my way to the MO. Will tell what he says soon !
Which MO, the one that said ARSIs don't rise T?
😆. Yes 🙄
No one is perfect!
So MO said he was ok as long as under 30 and to repeat again after few days and see if it remains below 30. And if not to switch to Zoladex.
Bilateral Orchiectomy April 2015 (almost 65yo) and I am steady at T≤2.5ng/dL
You take xtandi ?
Only Dutasteride since diagnosis.
You are non metastatic ?
Currently still non-met per Pylarify PSMA PET/CT earlier in year BUT 3 spots in remaining left half of prostate biopsied all 3 were 3+3 , right GL10 tumor was cryoablated and still clear.
Below 20
Thanks Ed. Dad’s latest T levels today have come to 29. Wondering if to continue the orgovyx or switch to Lupron. You take the 3 monthly Lupron ? Btw have got him up to 1750 mg metformin.
Many studies have shown that T < 20 significantly prolongs life, compared to T < 50. The level of "50" used to be the lowest they could detect using out-dated techniques. Even better is T < 10.
Here you go...
Low testosterone is better
Thanks. Will show my MO tomorrow 😊
"Patients and methods: Data were pooled from three prospective, 9–12-month Phase III studies of triptorelin monotherapy in patients with advanced prostate cancer (including NCT00751790)"
bjui-journals.onlinelibrary...
Of course, NO ARSI administered along with ADT as the results of the 3 trials predate Enzelutamide.
THINK before opening your mouth Tinkudi !
Hi !
Just to understand the picture you show. What was the study about? Did they test different types of ADT or was it only one ADT and they compared OS depending on lowest level of T or was the test ADT in combination of other treatments.
Just from curiosity and it looks very good the lower levels you reach but I still don’t see the context (or maybe is just stupid 
)
Best wishes - Ulf
It's just Lupron (etc.) ADT. No estradiol ADT. I'd have to dig up the paper and review it.
I think I listed the reference below, if you would like to look it up.
Yes, there is a huge beneficial effect on OS by going to very low T levels. That's my take on it.
Bob in New Mexico
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