Testosterone Levels -- Post SBRT

[Hope4Happiness]

Would like to get some info/opinions on testosterone levels following SBRT.

Background: I was treated for G7(3+4) prostate cancer at MSKCC in NYC in November 2021.

Since that time, my PSA is now down to 2.47 -- down from 8.78 right before treatment.

My testosterone level, however, right before my treatment was 702. Four months after treatment, it was down to 518. Seven months after treatment it rose back up to 608. Now, 13 months after treatment (December 2022), the reading came back at 841 (!).

Is this a serious cause for concern?

I'm a 57-year-old male, 6' 3", 170 lbs., with normal blood pressure and pulse -- Could this be a developing problem?

I'm a bit programmed (like a lot here!) to keep all eyes focused on that crucial PSA number after radiation treatment (and I'm quite happy with that reading), but could the testosterone number indicate that something is brewing?

Thanks in advance for all your responses, and happy and healthy holidays to you all!

[Tall_Allen]

The depression in testosterone levels after radiation sometimes happens. Glad it returned so well!

[Hidden]

First off, I'm surprised your PSA is still at 2.47 after radiation. Second, I think your testosterone level is fairly high. I don't know what mine was before IMRT radiation but my PSA is down at .2 and my testosterone is between 500-600. Testosterone feeds cancer and with a PSA of 2.47, I would be a bit concerned with that high of a level.

[Alexandr1]

Please read the many published works of Harvard urologist Dr. Abraham Morgentaler before assuming testosterone in any way “feeds” prostate cancer. He has shown for the last twenty years in study after study, no connection. In fact, believes low T might in some ways be a factor which induces PC. I have been treated for PC and use a T supplement upon the advice and concurrence of three PC urologists…..

[WilsonPickett]

Hello Hope,

You and I had treatment at MSK within one month of one another. I too had Gleason 7-3-4. At last reading my PSA was down at 1.35 and my testosterone 380, although I am 10 years older than you.

The one downside with this website, just like medicine in general, is that the divergent opinions can make you nuts. If you’re confident in the people that treated you at MSK, I would speak with them. They’ve always been very available to me. And if you have your doubts, there are really enough rockstar level medical oncologists that you can go and get an alternative opinion right here in NYC. Or even a tele-visit at Hopkins. We have similar diagnosis and treatment, and I also was not prescribed any hormone therapy. Remember, there’s a risk of making yourself crazy. We will always be looking over our shoulders, for me the key is how much…

[Hope4Happiness in reply to WilsonPickett]

Hey there WP -- Yes, I'm just throwing out the question here just to get perspectives and experiences because I have access to this rich resource.... I have a follow-up appointment scheduled with Dr. Zelefsky in about a week, so his perspective on this will ring the loudest with me.

[mchale in reply to WilsonPickett]

"Remember, there’s a risk of making yourself crazy. We will always be looking over our shoulders, for me the key is how much…"

So true, I'm exhausted and wiped out.....I went crazy I think....I know I've been mad, I've always been mad....Pink Floyd

ready to take the plunge at MSK....had my simulation last week.....Dr Nagar highlty recruited.....is Zelefsky replacement...will have SBRT on the Electra MRI Linac

[WilsonPickett]

I've found him to be more on the casual side of things, which tends to make me sometimes doubt him, then I have to remember to get out of my own way. The guy's been doing this for 40 years at one of the top hospitals in the country, I best trust him. The only time I've seen him go against that grain is in priming me for a two year biopsy. Interested in whether he makes that recommendation to you as well.

[TFU589]

Not sure if this is relevant to SBRT or other radiation treatment, but has to do with testosterone levels. Have not done much reading on the topic but watched a youtube done by Dr Aherling earlier this year.

Dr Ahlering at UCI

youtube.com/watch?v=R4H5JpI...(Not working as expected?)

Evidence for the integration of total and free testosterone levels in the management of prostate cancer

pubmed.ncbi.nlm.nih.gov/347...

Conclusion: In contrast to popular belief, testosterone remained stable in men aged 40-80 years, whereas free testosterone decreased by 2-3%/year. Low cFT was an independent predictor of very-high-risk PCa and BCR.

Testosterone replacement therapy reduces biochemical recurrence after radical prostatectomy

pubmed.ncbi.nlm.nih.gov/321...

[NYC_talker]

Hi Hope4.

From my own reading, the idea that testosterone ,or a normal elevation of it, advances prostate cancer -- this issue of "feeding" it -- has been put to bed by scientists. The misunderstanding about testosterone stems from the fact that depriving the body of testosterone for more advanced prostate cancer helps to slow down the cancer -- using ADT.

But too much (or rather, a normal amount of) testosterone doesn't cause cancer to grow. The metaphor that I saw used by a prostate cancer oncologist presenting at a conference was that of a plant in a well-drained pot or soil, with the plant being like the cancer and water being like testosterone. Depriving water will kill the plant, but too much water will just drain out. You're younger so it would be expected for your testosterone to be higher. It's good that your testosterone went back up.

My level was 618 a year ago before I had LDR. It dropped to 355 at four months after treatment. It's now risen to 457 on my last labs last month. I assume it will go higher. I've felt nothing different, by the way. I work out a lot, have had no drop in activity or ability to lift weights. And no difference in sex drive through the whole time.