TRT and the PCa patient...

[Don_1213]

I was updating my bio, and thought I'd post some of it here, as I've posted before about my intention to do TRT despite having Gleason-10 PCa..

BTW - I was never metastatic.. but was G10 with enough cores positive to make the outcome of treatment quite hard to predict. If anyone has an issue with me posting this here - I'll ask Daryl to delete it and post it over on the other PCa forum.

I started the TRT at the end of 2024.. I did have a thread about this, but didn't want to bring a necro thread back to life, so here goes:

Update 12/4/2024 - Started TRT therapy early-December 2024 due to decreasing testosterone levels causing lots of health issues.

This might sound a bit risky - but it is a question of "Quantity of Life" vs "Quality of Life". This started based on my GP's suggestion that I speak with my medical oncologist about the possibility of TRT (Testosterone Replacement Therapy) perhaps helping with the issues I've had for the past several years with my legs and walking.

Short version - a combination of peripheral artery disease (PAD) and some nerve impingement between L3 and L4 has caused me difficulty in walking any distance, or even standing stationary for any time. I've also experienced symptoms of male hypogonadism - which I'll let you look up - but basically no libido, moobs, easily fatigued, loss of muscle mass - bad stuff. My GP thought that TRT might help if I got clearance from my prostate cancer oncologist.

My oncologist (who I've become friends with) and I had a long talk about QOL vs QOL, and the possible risks involved. The latest thinking on TRT is that:

(1) It's reasonable for someone with a very low T level to bring the T level back to a normal level for your age level

(2) It appears that if the cancer isn't currently active - bringing the T back up doesn't increase the chances of recurrence - and it might do just the opposite

(3) This should be done with close monitoring - frequent PSA tests

(4) The patient and MD shouldn't panic if PSA rises to a level "normal" when the patient's T is normal.

After I finished ADT - it took about 6 months but my T finally crossed over into the "normal" range for someone my age (at the time 74) - and it stayed there for several years, then started dropping. It finally fell to around 180, and my PSA dropped to 0.09. That's when I started TRT...

12/17/24 - 2 week PSA/T test - PSA remained at 0.09, T climbed to 450

01/28/25 - 6-week PSA test - PSA climbed from 0.09 to 0.23, while T climbed from 450 (12/17/25) to 540 (1/28/25) - the climb in PSA trailed the increase in T - which was expected, as was the increase. My PSA had hovered around 0.22 or so for the entire time when I had sort of normal T levels after coming off ADT, so this level isn't the least bit concerning to me.

Interesting paper/discussion on TRT and the PCa patient: urologytimes.com/view/testo...

Another: urologytimes.com/view/alexa...

02/04/2025 - I can now report - about 8 weeks after starting weekly injections, my legs feel better than they have in several years. I can do significantly more at the gym on a stationary bicycle and not have leg cramps at night. My feet finally feel warm. I'm recovering my libido (interest in sex, not that there is much I can do about it), and generally have a feeling of "feeling better" over what I had been experiencing the past few years as my T disappeared.

03/11/25 - Next 6-week PSA test (14 weeks total). PSA dropped to 0.21 while T climbed to mid 600's (639)! Great results. My overall health - improving. Fewer other blood tests are out of range now. My legs are better (not perfect - but better), energy is up, mood is up and I get horny sometimes. So far - so good! I'll be talking with my oncologist next week - I'm sure he'll be delighted with the results of our experiment so far!

[Jpl506]

I think you stand a great chance of it being fine. Also G10 and my T has been around 900 since about 4 months post ADT so about 2.5 years now. Latest 3 month PSA yesterday was the fourth in a row at 0.17.

[Don_1213 in reply to Jpl506]

Thanks for the vote of confidence.. it helps! Am I correct in assuming you did ADT/Radiation as your treatment? Just curious - how long were you on ADT?

[Jpl506 in reply to Don_1213]

SBRT 5x8gy prostate and SV only and 2 years Lupron+Apalutimide.

[Don_1213 in reply to Jpl506]

Similar - 83G IG/IMRT/ARC, prostate and bed, 18 months Lupron. It's great to hear it's working for you.

[Scout4answers]

Thanks for sharing , this GS 9 will follow your progress with interest.

[Mgtd]

I will join the choir and say you are doing OK! I am not on TRT but your results mirror my experience after coming off ADT and the return of my T.

[Shepherd0822]

Hi,

There is no evidence that TRT increases PCa risk.

citation is below

Fundamental Concepts Regarding Testosterone Deficiency and Treatment

Morgentaler, Abraham et al.

Mayo Clinic Proceedings, Volume 91, Issue 7, 881 - 896

[Don_1213 in reply to Shepherd0822]

@Shepherd0822, Thanks! Searching on that citation, turned up: youtu.be/6_0PAsxefLo?si=15s...(Not working as expected?) - by Morgentaler which is really quite interesting, digging down into the claimed link between PCa and T - the theory was based on the results of one man. It's a short and interesting video..

A longer video by Morgentaler: youtu.be/6a0vvEh_GtE?si=_T3...(Not working as expected?)

[Don_1213 in reply to Don_1213]

BTW - on the longer video - the question about saturation and increased PSA doubling time - to a steady state PSA is covered at about 15 minutes into the talk.

You can go to that point directly with this link: youtu.be/6a0vvEh_GtE?si=ySy...(Not working as expected?)

The is very much similar to what I've observed with PSA vs T - once the level of T supplimentation passed 400 or so - the PSA was the same as when T was around 350 naturally. As Morgentaler predicted - it saturated.