Prostate Cancer & TRT

[ocman]

I'm having the first of two sessions (1 week apart) this Friday 2-7-20 of HDR Brachytherapy. I was diagnosed in 10-19 with Gleason 4+3, localized.

I was on Testosterone Replacement Therapy since 8-16.

My Medical Oncologist recommends that I start TRT after the second session of HDR Brachytherapy, but my Radiation Oncologist wants to wait 6 months.

I know there's 2 schools of thought regarding TRT, but if you believe in Dr. Abraham Morgentalers' research, it seems like TRT is the way to go.

grandroundsinurology.com/te...

Your thoughts?

[Tall_Allen]

There are 2 separate issues:

(1) does TRT fuel PCa growth in men who have been radically treated? - the answer seems to be no

(2) BUT - after brachy your only biomarker of success or failure is PSA. So by taking TRT which is definitely known to increase PSA from benign causes, how will you measure whether the treatment you had was successful or is failing? In other words, if you start TRT after brachy and your PSA increases, is that cause for further exploration of clinical recurrence?

I don't think there are 2 schools of thought about this.

[ocman in reply to Tall_Allen]

(2) Yes, that's a good point, but according to Morgentaler, when taking Testosterone there might be a short rise in PSA then after a saturation point it levels off.

Of course, in a perfect world, after the brachy the PSA is on a steady decline. If you start a course of TRT and you get a rise in PSA, then it levels off, then the PSA continues to decline you would know.

[Tall_Allen in reply to ocman]

Morgentaler never addressed this as far as I know. He did not say that PSA would level off in your situation. He only said that androgen receptors become saturated at low levels of T. With BPH, there is hyperplasia and an increase in the number of ARs. Also, with BPH, PSA can continue to grow unpredictably. You are in a completely different situation from what he addressed.

[LowT]

Would be interested in your free testosterone and DHT levels.

[ocman in reply to LowT]

They're checking my T and PSA before the procedure on Friday.

[LowT in reply to ocman]

free Testosterone and DHT are different tests.