Testosterone Level after RT plus six months ADT

[thierry]

Hi , French man , 68 y.o , fit , discovered PCa , in January 2020 , 11 mm in left lobe , PSA 5,3 , Gleason 3+4 , 2 cores among 15 , 7% of score 4 . Underwent RT , 38 sessions , on Prostate , 78 Gy and 54 Gy on VS . Had ADT , 2 injections of Enantone / Takeda , Today my PSA is at 0,06 and T at 0,7 nml/l , very low , I feel OK except ED . I would like to compare my situation with others considering that the HT should cease end the coming October . Regards

[cesces]

Thirty

You maybe might get more response by adding more details and avoiding the use of acronyms.

[timotur]

I'm on monthly Lupron shots the last 17 months and T has been consistently <0.12 ng/ml, except for one month I was late three weeks on one shot due to CoV and T nearly recovered to lower limit, so hoping it comes back quickly after my last injection in September. PSA has been n/d last 10 months (see profile for details).

[jkm100 in reply to timotur]

Right there with you! 15 month shot a couple weeks ago. Looking foward to post November.

[timotur in reply to jkm100]

Congrats on nearing the end of ADT, pulling for you and a quick recovery to normal-T...!

[jkm100 in reply to timotur]

You too my friend!

[doc1947g in reply to timotur]

Why monthly Lupron for 17 months. I would go for Lupron Depot 45mg/24 weeks (6 months)

[timotur in reply to doc1947g]

I contemplated 3/6-months injections, but thought the SE's would be lower with monthly due to lower peak concentrations of leuprolide. All doses appear to have the same efficacy in lowering T-levels, but some of the SE's like hot flashes appear to be of higher intensity with the higher doses in the studies I've read.

[doc1947g in reply to timotur]

You maybe right. After my second injection of Lupron Depot 22.5 mg/12 weeks, on the second week the SEs were bad but they disappear now. Being intra-muscular injections, they are more painful than the sub-cutaneous. Two of those are better than six of them.

[thierry in reply to doc1947g]

Hi , thank you , you gave me good advices . And also , the best is to recover some testosterone while the PSA remains low ( 0,10 to 0,25 ) for a long period of time , the two should go in opposite direction. After treatment of RT plus ADT for an intermediate risk , the next 24 months are also very important , you have the nadir to consider , and if everything remains stable , then the success is probable . Regards

[thierry in reply to timotur]

Hello , ng/ml or microg/l is the same . Mine is 0,21 ng/ml , a bit more than yours , and considering that the normal Testosteronemy fetches 2 or 3 or 4 or 5 ng/ml , more than ten times than we currently have , we have a long way …. Best regards

[Jimhoy]

Don’t expect that Oct = back to normal!!! That may be when you are scheduled for another 3mo dose but it doesn’t mean its out of your system. As it weans out, at some point, your T will rebound. Many say it takes up to a year! I was still full blown ADT 10 months after my last 3mo Eligard with T @18. My T history is 100 @12mo, 317 @16mo, 396 @19mo, 401 @22mo & 410 now.

Remember..... you were temporarily castrated!!!!

Everyone is different but it doesn’t come back quickly!!!

Jc

[thierry in reply to Jimhoy]

Hello Jimhoy , thanks for your reply . So , I had ADT , six months , theorically from MAY to OCT , consisting of two shots of Enantone / Leuproreline Acetate 11,25 mg , by subcutaneous injection in the abdomen . This product made of microcapsules , constantly liberates the princeps during three months . My only T test , on August 18th , showed 0,21 microg/L when the normal rate is 1,75 to 7,80 , and my PSA was at 0,08 . I will make a second test three months away , November 18 th . Today I am half way for this second and last , I hope , ADT shot . I am counting the days but If you tell me that the SE will last longer , that causes me some dismay . I am 68 , fit , doing swimming and gym , Everyday , even in winter , I live near Monaco , and I follow a strict diet , no Added sugar , no fats , no meat , but veggies , porridge , berries , etc . My side effects from this treatment are low , even during the RT , but my skin has dried and wrinkled a bit , ED is still there and I Don't feel like wanting sexual relation as my girlfriend dont bother me about it . I have no right to complain to my GF who underwent heart surgery three years ago . I will have to be patient . Best wishes .

[Jimhoy in reply to thierry]

Best of luck! Everyone handles ADT differently. Your lifestyle is surely on your side for a speedy rebound. At the end of the day, I hope it helped you kicked PC’s A$$ for good!!!

Jc

[doc1947g in reply to thierry]

In Québec, we use the nMol/L instead of ng/dL. The conversion is :

1 nmol/L = 28.8184438040346ng/dL.

So my testostérone level is 0.3 nmol/L or 8.645533141 ng/dL.

so I do not understand the "showed 0,21 microg/L when the normal rate is 1,75 to 7,80"

because another time you said : "Mine is 0,21 ng/ml "

One month after the ADT my PSA went from 22.4µg/L to 0.18µg/L then 0.03µg/L and last Dec 0.01µg/L.

My latest Testosterone on Dec 15 2020 went from <0.2 nmil/L to 0.3nmol/L.

My next test will be on March 1st 2021.

[thierry in reply to doc1947g]

Hello , I confirm my first ever T level , checked in August , three weeks after my second shot of leuproreline 11,25 . It is 0,21 microgram / litre or 0,7nanomole/liter . micro is 1000 times a nano .and a milligram is Worth 1000 micrograms . Best regards

[doc1947g in reply to thierry]

I notice that your testosterone level at 0.7 nmol/l is just borderline of the castration level:

Niveau sous-castration < 0.7nmol/L - < 20.189ng/dL

So your are not UNDER the castration level. You should get another test.

I just have my APS & Testosterone checked this morning, Should get the results in 2 days. In the same time, they check my Hgb (anaemia), Dre (Chonic Renal Insuff.) and some other tests for my Lymphoma. And I forgot my COPD.

Good luck.

[thierry in reply to doc1947g]

Hello , yes my T is borderline , I am on the limit , but I Don't see why 0 ,21 is too high and why I should need full castration , and much lower T as long as my PSA is 0,08 . I may ask my RO about this but I am pretty sure she will reply that my results are satisfactory . You know , I am 68 and during the past 8 months , from the diagnosis , I did a lot of exercices , gym in the Morning , then swimming in the Mediterranean , and some Walking in the afternoon , as i never did before , just to sweat , and to stay fit , I am 1,80 m tall for 73 kgs , and that probably had an impact on ADT , I am sure I eliminated that way some of the leuproreline injected , and so my T didn't go too low . But for the moment I feel all right , except ED and Tadalafil 5 mg per day does not really work but I feel it is going to slightly improve . I Don't want to go too fast , I was a pharmacist . Best wishes

[doc1947g in reply to thierry]

I am an ex-Inalotherapist but I was always interrested of the whole medecine.

As far as I understood, the reason to be "castrated" is to prevent the good and bad prostatic cells to get the testosterone that they need to grow.

So close to the castration level may be as good since your PSA is 0.08 μg/L.

My PSA is 0.18 μg/L but my testosterone is < 0.2 nmol/L or < 5.768 n.

Have a good evening.

[doc1947g]

I just notice. Your ADT was a sub-cutanous 11.25mg/12 weeks, mine were intramuscular 22.5mg/12 weeks.

Maybe that is the reason that my T is so low compare to your.

As a pharmacist, you may know why it is like that. Looking at this:

The NCCN intermediate risk group is currently defined as having any of the following:

- Stage T2b or T2c, or

- PSA 10- 20 ng/ml, or

- Gleason score = 7

(If multiple risk factors are present, the clinician may optionally deem it high risk)

Unfavorable Intermediate Risk:

That is me...

- NCCN intermediate risk, as defined above, plus

- Predominant Gleason grade 4 (i.e., Gleason score 4+3), or

- Percentage of positive biopsy cores≥ 50%, or

- Multiple NCCN intermediate risk factors

Favorable Intermediate Risk:

That is you...

- NCCN intermediate risk, as defined above, but only those with

- Predominant Gleason grade 3 (i.e., Gleason score 3+4), and

- Percentage of positive biopsy cores <50%, and

- No more than one NCCN intermediate risk factor

A study mention that the ADT is not recoomanded to the Favorable Intermediate Risk group. I can not find it but Tall_Allen know about it.

[thierry]

Hello , in France They make no difference between intermediete low or high . Gleason 7 , even a few , grants you the full treatment . I was probably overtreated and do not forget the last words of the urologist after gold markers put , prior to RT , a Young and nice lady , with a smile , she told me , do not worry . Best wishes

[JuliesHusband]

Not sure about the time frames. The effects are different for everyone as they depend on a number of factors. I was 74 while on treatment, had Gleason 7, intermediate favorable, T2b.

I had 28 sessions of radiation while on a 6 month program of lupron. My last 1 month lupron injection was August 4 so theoretically I headed into withdrawal the first part of September.

Just before the last luron injection my PSA was <.13 ng/ml, testosterone <12 ng/ml (officially and medically castrate). On November 2, two months into "withdrawal"/recovery from ADT my PSA was .3 and testosterone 359 (normal range) and I am noticeably no longer castrate.

ADT kills testosterone and physical libido, but for at least 15% or more men does not actually cause ED. ED can be based on expectations. I was sexually functional the 7 months I was castrate from lupron and other gents have had the same experience. Just more effort to get going.