I am now 63 years old and I was diagnosed with PC in October 2021 when I was 60. In February 2022, I had a prostatectomy and in Sept/Oct 2022 I had 37 salvage radiation sessions to clean up cancer cells in the pelvic bed. I was not prescribed Lupron since my testosterone level is undetectable due to HIV. I had been told that after two years of undetectable PSAs, I could begin receiving hormon replacement therapy. I have reached that milestone. But recently my PA consulted with a doctor (who has never seen me) who has discouraged hormone replacement therapy. This is very disappointing to me since I have little libido or motivation to get back into gym workouts and I have gained weight. I would like to know how high a risk there is of the cancer returning if I begin testosterone replacement? Does the risk of returning to testosterone replacement outweigh the benefits?
Testosterone Replacement Therapy or Not? - Advanced Prostate...
Testosterone Replacement Therapy or Not?
Testosterone replacement is counter-indicated if you already have painful bone metastasis because there is a very real possibility that it could make those metastasis grow bigger.
But even if you do not have bone mets already, it remains a gamble and I think that the risks vs benefits is a personal matter that will be different to everyone depending on their perspective.
From my understanding, low T is enough to feed prostate cancer and normal to high T does not create more of a risk than low T.
So in my view, if after your 2 years of ADT, you doctor was fine with a vacation from ADT, which is a risk in itself, then adding more T should not increase the risk. In this scenario, I would see a potential benefit of feeling better thanks to T supplementation.
However because you've mentioned that you do not produce T, then injecting T gives you more risk than for someone who already does generate his own T when on ADT vacation.
Hoping someone here will have more info to provide you on the pros and cons for someone in your special situation.
I respect your opinions, Mascouche, but I respectfully question your last statement , where you say: "However, because you've mentioned that you do not produce T, then injecting T gives you more risk than for someone who already does generate his own T when on ADT vacation."
Can you provide a reference that supports this assertion?
Thanks.
Bob in New Mexico
Hi Janebob99. I was not reading from a reference. I simply deduced this from the treatments most of us here are getting. We take ADT to bring T to neutralize T in order to fight our cancer, right? Since JFBNY does not produce T, it is like if he was on ADT but naturally.
When we go on ADT vacation, which does eventually bring back our T for many of us, we do so knowing it carries with it a risk of the cancer recurring (or growing since it is likely still there dormant or too small to be detected. So for most of us, injecting T while on ADT vacation is going from SOME T to MORE T.
For JFBNY, he does not start from having SOME T but from having NO T at all. So for him isn't getting injected similar to us stopping ADT, giving cancer a chance to grow? My RO wants me on ADT for life. My MO, who understands the side-effects I get from it, simply begs me to take it for at least 9 months but he knows full well that I will be taking a ADT vacation whenever I decide to. At this point my decision is to wait until Nadir plus a month or two and to try my luck a second time.
I am not against T injections as I consider doing it for myself when I next take a ADT vacation. But in my case, I know that soon after I begin my vacation my T will come back at low levels which is considered the riskier category and going from low T to high T might prove protective.
Every statement above are just my opinions. To look at what others might thing about this, I've asked the perplexity AI this question: When it comes to already having stage 4 prostate cancer that is dormant, can you please describe the nuances in risks of recurrence for someone with no testosterone at all, someone with low testosterone and someone with high testosterone?
And this statement from its answer reflect what I was saying about the situation of JFBNY about his having no T: "Generally considered the safest option for preventing recurrence in advanced prostate cancer".
Below is the AI's full answer:
When considering the risks of recurrence for stage 4 prostate cancer that is currently dormant, the relationship between testosterone levels and cancer behavior is complex and not fully understood. However, based on the available research, we can describe some nuances for different testosterone levels:
No Testosterone
Typically achieved through androgen deprivation therapy (ADT)
Generally considered the safest option for preventing recurrence in advanced prostate cancer
May keep cancer dormant for extended periods
However, some cancer cells may eventually become castration-resistant
Low Testosterone
May occur naturally or as a result of partial ADT
Associated with more aggressive prostate cancer at diagnosis1
Some studies suggest higher rates of extraprostatic invasion and higher Gleason scores in men with low testosterone (pmc.ncbi.nlm.nih.gov/articl...
Paradoxically, low testosterone has been linked to increased risk of prostate cancer in some studies (pmc.ncbi.nlm.nih.gov/articl...
High Testosterone
Traditionally thought to increase risk of recurrence
More recent studies challenge this view:
Some research shows no increased risk of prostate cancer with higher testosterone levels (tau.amegroups.org/article/v...
A few studies even suggest a potential decreased risk of prostate cancer with higher testosterone (tau.amegroups.org/article/v...
May improve quality of life for patients but carries theoretical risks
Nuances and Considerations
Individual variability: Response to testosterone levels can vary greatly between patients.
Prior treatments: The effect of testosterone may depend on previous therapies, especially if the patient has undergone ADT.
Tumor characteristics: The specific genetic and molecular features of the cancer can influence its response to testosterone.
Duration of dormancy: Longer periods of dormancy may reduce the risk of recurrence regardless of testosterone levels.
Monitoring: Regular PSA testing and imaging are crucial for detecting early signs of recurrence, regardless of testosterone levels.
Quality of life: Higher testosterone levels may improve symptoms like fatigue and sexual dysfunction, which needs to be balanced against potential risks.
Adaptive response: Some research suggests that prostate cancer cells may adapt to changing hormone environments over time.
It's important to note that the relationship between testosterone and prostate cancer recurrence is still an area of active research and debate. The decision to modify testosterone levels in patients with dormant stage 4 prostate cancer should be made on an individual basis, considering the patient's overall health, quality of life, and risk tolerance, in consultation with their oncologist.
*** End of the AI's answer.
Hope this helps!
Hi, Mascouche.
Thank you for your detailed response.
The AI response is useful, because it provides links to actual references, which is the best way to assess if and whenTestosterone supplementation is protective or hurtful. I think there is no substitute for controlled, randomized (RCT) research studies. Otherwise, we are just speculating (I think Tall Allen would agree).
Pertaining to the poster's question, one should also consider the BAT protocol, which gives a super-high dose of testosterone periodically (e.g., once a month) to re-sensitize castrate-resistant PCa cells in castrate-resistant men who are on ADT. It works well in some men, but not all.
By the way, I have hypogonadism due to a micro-adenoma on my pituitary gland. So, I will definitely be taking TRT after my ADT is over in a few months. Of course, I will monitor my PSA closely. Currently my PSA is 0.08, so I am close to a nadir.
You mentioned that your MO wants you to be on ADT basically forever. Have you, or would you, consider switching to Estradiol ADT, based on the recent PATCH-III trial results? Those 2024 results (after 14 years of study) showed that you can safely and effectively substitute Estradiol for Lupron (LHRHa) ADT, with no increased risk of cardiovascular events (CVE's), and with the same rates of OS and MFS as Lupron ADT, out to 14 years. Plus, estradiol ADT has significantly reduced hot flash intensity and frequency, and essentially no osteoporosis (net bone growth is common), among other beneficial things (compared to LHRHa ADT treatment).
Bob
It is my RO that wants me on it forever. My MO is closer to my way of thinking.
I don't feel the need to try estradiol just yet and that too would be an upward battle even with my MO.
My shoulder blade met was zapped at the end of June. I will wait for the result from my last bone scan to see if there is anything left that needs zapping.
If all is in the clear, I am leaning towards an ADT vacation. Then I will ponder whether to try TRT at this stage or to wait some more.
Taking it one day at a time 
Bravo - excellent response and accurate too !!
Men who have had curative therapy and get TRT actually have lower rates of recurrence than men who don't get TRT. Show these to your doctor:
bjui-journals.onlinelibrary...
ascopubs.org/doi/10.1200/JC...
Many think that T plays a protective role in keeping the prostate healthy. Men with chronically low T, have higher rates of prostate cancer.
Testosterone doesn't cause prostate cancer, but eliminating all of it can prevent prostate cancer that is already there from growing. To make sure that you have successfully eliminated your prostate cancer, it is necessary to proceed cautiously. Just get enough to have normal levels and get monthly PSA tests for the first few months.
Thank you, Tall Allen.
Excellent response!!
From the paper by Ahlering, et al. that you referenced, it reports:
"After accounting for GGG [Gleason Grade Group], pathological stage, preoperative PSA level, and cFT, patients on TRT [Testosterone Replacement Therapy] were ~54% less likely to recur (hazard ratio 0.54, 95% confidence interval 0.292–0.997). In men destined to recur, TRT delayed time to recurrence by an average of 1.5 years."
Clearly, doing TRT after receiving "curative" treatment is a safe and desirable thing to do.
Bob in New Mexico
The curative treatment was RP for the patients in the study. Is IMRT + Eligard + Xtandi + SBRT for one bone met and PSA <0.1 curative?
I did not get a baseline testosterone level prior to my RP, salvage radiation and ADT. So I don’t have any idea what it was. I can only assume that it was at least normal as I had a great sex drive and no performance issues. Now, I am 5 months post-ADT and T remains very low and I have no libido. Doc says that T recovery will likely happen but takes time.
If it remains low, should I considerTRT, not knowing my original baseline?
Still hoping for some return to normal
I agree with your doctor.
Allen,
Exactly my thinking and that of my MO (Drake, and my GP). The current papers I've seen link higher T levels with reduced chance of recurrence - especially among men who have had low PSA for an extended period of time that didn't track changes in T levels.
My T right now is 249 - up from around 110 a few months ago. My PSA has been steadily declining for the past 3 years since I came off ADT. Right now it's heading toward undetectable. My treatment was intended to be curative (see bio for details) and appears to have done what was intended.
I'll be starting T supplementation shortly. My goal is a T level of a healthy 50-year-old, and I think that reaching that level, no matter how—naturally or via supplemental treatment—gives the same risk factor for recurrence of the PCa.
There will be monthly PSA, T and some other blood tests to monitor the treatment result. My hope is it will help me lose the extra 30lbs I'm dragging around with me and perhaps help cardio-vascular issues.
Once you start TRT, you can never stop. If your T is increasing on its own (maybe with help from clomid or hCG), you might want to see how high it can go on its own.
Hi !
Are there any studies showing how the rates look like for persons having had curative intended radiation therapy and adt and have had TRT or not?
Rates of what?
Sorry rates of recurrence when having TRT or not; like with the studies you posted for persons having gone through Prostatectomy and having TRT or not. Or perhaps this is not valid question when you’ve had radiation and ADT?
nature.com/articles/s41391-...
Thanks TA and it seems like your not worse off if being needed to be treated with Testosterone therapy compared to those not needed if you look at recurrence.
Good to know if / when I’m able to come off Orgovyx and Abiraterone and my T-levels don’t recover. That’s a story for the future anyway
excellent second follow up response !!!! Mr Allen
to JFBNY... would you be kind enough to update your bio? It helps you and helps us too. All info is voluntary. Thank you!!!
Good Luck, Good Health and Good Humor.
j-o-h-n
Testosterone slows prostate cancer recurrence in low-risk patients
ADT Vacation/What PSA to Resume and Prostate Cancer Bipolar Therapy With Testosterone
Surprising TRT research results in PCa patients
