Hey guys - I’ve been through the fire and made it out the other side. I’ve been stage 4 for 9 years. Currently on pembroluzimab for last 5+ years (47 infusions now).
I stopped Lupron over a year ago (14mo). I had been on Lupron for the 8 years prior. My PSA is slowly creeping along with my low T. PSA is now 0.09 and T is 95. It’s been fluctuating between 90-158 for the last several months.
Wondering if it might be possible to get back to normal. I’d be curious as to what you think about the risk of TRT waking the Dragon? I know we’re not supposed to think about curing stage 4 - but pembro is just different.
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Chugach
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Happy to hear you are doing so well on Pembro and off ADT to allow T to recover. Unfortunately many never regain normal testosterone levels. So TRT is perfectly reasonable to do the same thing. As long as you monitor as it can be stopped if PSA takes off. Even in that case it is unlikely to be harmful, just as BAT trials have demonstrated. You would like having normal T even for a little while. Do you have a HRR gene mutation that favors the PARPi?
You may want to research the papers by A. Morgentaler, Harvard University school of medicine. He has written extensively on the advantages of having high testosterone levels concurrent with advanced PCa.
I'm currently taking TRT after 6 months of Orgovyx, and it's important to monitor PSA and T every 1-2 months to watch for a gradually increasing PSA.
Yes - agree with you JaneBob. Dr. Abraham Morgentaler's long career as a urologist and frequent prostate cancer/testosterone published clinical study leader has been interesting and arguably groundbreaking.
The many Dr. Morgentaler You Tube interviews on this subject should be worthy of consideration.
TRT can, indeed, "wake the dragon. I would consult an expert about this such as Morgantaller in Boston or Dunmeade at Hopkins. This should be done under the watchful eye of an experienced MO.
My husband was on Lupron & Casodex for 9 months after his Prostatectomy revealed +nodes. That took his PSA down to undetectable levels. He lived for 16 years with no further treatment (active surveillance). His testosterone rebounded on its own. He had a variety of other treatments after that but the experience with the short term Lupron was wonderful.
What's the lowdown on Testosterone Replacement Therapy (TRT) and Prostate Cancer.
From King A and Queen I.
ChatGPT said:
Testosterone Replacement Therapy (TRT) is commonly prescribed to men with low testosterone levels (hypogonadism), which can result from aging, medical conditions, or other factors. The therapy aims to restore testosterone to a normal range and improve symptoms like low energy, mood disturbances, decreased libido, and muscle mass loss.
The link between TRT and Prostate Cancer:
The relationship between TRT and prostate cancer has been a topic of controversy and research for many years. Here's a breakdown:
1. Prostate Cancer and Testosterone:
Testosterone is a key driver of prostate cell growth, and in theory, increasing testosterone levels could potentially stimulate the growth of prostate cancer cells if they exist. This concern stems from the fact that prostate cancer often grows in response to male hormones (androgens), including testosterone.
2. Historical Beliefs:
For a long time, the prevailing belief was that testosterone therapy could fuel the growth of prostate cancer, particularly in men who were already at risk or had existing prostate cancer. As a result, testosterone therapy was typically avoided in men with a history of prostate cancer or in those with elevated prostate-specific antigen (PSA) levels, a marker often used to screen for prostate cancer.
3. Current Research and Understanding:
Recent studies have challenged the idea that TRT directly causes prostate cancer or worsens existing prostate cancer in men who are already cancer-free or in remission. Some key points from current research:
Men Without Prostate Cancer: Studies show that TRT does not appear to increase the risk of developing prostate cancer in men who are otherwise healthy and do not have a history of the disease.
Prostate-Specific Antigen (PSA) Levels: TRT can cause an increase in PSA levels, but this doesn't necessarily mean cancer is present. It's important for doctors to monitor PSA levels carefully when prescribing TRT.
Existing Prostate Cancer: For men with prostate cancer, TRT is generally not recommended, especially if the cancer is active or high-risk. However, some research indicates that low testosterone levels may be a consequence of advanced prostate cancer, so addressing low testosterone could potentially be helpful in certain cases, but this must be handled with extreme caution.
4. Screening and Monitoring:
For men undergoing TRT, doctors typically conduct:
Regular PSA screenings
Digital rectal exams (DRE)
Monitoring of testosterone levels to ensure they remain within a safe range.
5. Key Takeaways:
TRT is considered safe for most men without prostate cancer or significant risk factors, but regular monitoring is essential.
Men with a history of prostate cancer or high PSA levels should avoid TRT unless they are closely supervised by a healthcare professional.
There's no conclusive evidence that TRT directly causes prostate cancer, but caution is necessary in men with pre-existing prostate conditions.
In short, while there's a theoretical risk that TRT might exacerbate prostate cancer in certain individuals, the current evidence doesn't definitively support that it causes prostate cancer in healthy men or worsens it in those without active disease. However, if someone has a history of prostate cancer or elevated PSA levels, TRT should be approached with great caution, and regular medical monitoring is essential.
honestly this will have to be your call with very close surveillance. I had a doctor who told me of a guy that came to him with severe pain in lower back and hips. Tests revealed psa of over 7000 and extensive spread through bones and nodes. He got 2 shots of Lupron over 3 months tempered with 30 days casodex. He never returned for futher treatment until he had hip pain many years later. Figuring it was the cancer again he went back to the urologist only to find no cancer and a psa of 1. He had a hip replacement and went back to his farming.
There are two ways of looking at this. One is the way the uro who looked at the guy did. He told me this is a one in a thousand case. When I told my new uro the story he said it could be a one in one case but nobody has the courage to really try it.
I had G9 with prostatectomy and appearance of a bone (T8) met within 6 months. SBRT. Four months later rapid PSA doubling with pelvic nodal met on PSMA PET. Went to Johns Hopkins and had triple therapy and 2 months later pelvic radiation. Off Lupron after one year. Undetectable PSA for >2 years but T never returned. My JH MO put me on TRT. Feel so much better and actually turn my head now when a pretty woman walks by! PSA remains undetectable 4 months on TRT. It's all individual and up to you and your physician. Not for everyone.
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