Here's a plot showing the Odds Ratio for having either Intermediate Risk PCa or high-risk PCa, as a function of baseline testosterone levels.
The Odds Ratio tells the likelihood of getting PCa, compared to a reference value of 1. So, for example, for the lower plot (high risk), a testosterone level of 100 ng/dl, the Odds Ratio = 7, meaning that a man with 100 ng/dL will be 7 times more likely to get high-risk PCa than a man with a testosterone of 1000 ng/dL.
These plots also show that for hypogonadal men, with T-levels = 50 ng/dL, that the odds ratio can be as high as 22 times more likely to have high-risk PCa than a man with 1000 ng/dL. Yikes !
This relationship impacts older men greater (who naturally have lower levels of testosterone) than younger men.
No one has data on that for modern Transdermal Estrogen Patch (TDE) therapy. I spoke to the lead researcher (Ruth Langley) yesterday on the UK PATCH trial, and she said that the Phase-III results on 5-yr and 10-year survival outcomes will be published this Fall. Most people predict that the Estrogen Patch will be non-inferior to Lupron ADT. Stay tuned.
I do have a plot somewhere (can't find it...) comparing Lupron to Oral Estrogen from decades ago that show no difference in survival probability vs time between the two. That makes complete sense, because they both work the same way (i.e., they castrate you by interfering with the production of FSH and LH hormones). The important factor is how much the testosterone drops due to castration (see my other posts on Testosterone Nadir).
Also, here's a chart of Treatment Failure Time (PSA recurrence) and Overall Survival Time comparing Flutamide ADT (similar to Lupron) to Oral Estrogen (DES). Oral estrogen has significantly longer survival times (don't know why...but, it may have castrated men to lower levels of testosterone nadir).
Note that Oral estrogen was discontinued due to blood clots. The new TDE delivery method prevents clots from forming.
Thanks ! Now 75,with Gleason 9, my T has bounced around in the 500-600 range. So, these types of studies are NOT predictions,,,,,,,,,,,,,,,,,, though I suppose the results might somehow help clinicians and their patients? Maybe somewhat related to my clean PSMA PETS over the last 2-3 years.......trying to bite the bullet on accepting ADT as part of RT treatment in the next few months. Did the study show any relationship between baseline T and PCa mortality. My uro mentioned that my relatively high T for an old man might be a negative re PCa aggressiveness? But, does a study actually show that association? Can you provide the link?
Here's a plot showing the association of Low-baseline T with Prostate Cancer Specific Mortality Survival (PCSMS). Higher baseline-T has better PCSMS survival than low baseline-T. The differences are significant. Reference at bottom of slide.
I suspect your higher testosterone (500-600) would have even better survival probability.
Unfortunately, no one can explain why this association exists...
Thanks again! While the T nadir plot was encouraging,not meaningful yet for untreated men...other than serving as a goal during treatment! On the other hand, the survival asociation using oral estrogen versus Lupron just might help in discussions with Docs!!!!!!!! If that same thing shows up in the Patch trial, that would be pracctice changing????
Absolutely! I do expect the PATCH report to be game changing. It will be published this Fall, according to the lead researcher that I spoke to a few days ago, Ruth Langley.
Hey J-Bob. I'm also in the camp that I quite enjoy these posts. Very informative and as an engineer, gives me something solid to chew on. I also much appreciate some of the comments about how to interpret the data, which can be misleading in some cases.
Thank you for your kind remarks. We engineers have to stick together!
I have a Ph.D in Nuclear Engineering from the University of Wisconsin-Madison, and 2 Masters, and 2 Bachelors degrees, all in Mechanical and Nuclear Engineering.
I really enjoy discovering trends from data and plotting them. I hate long tables of numbers, which are common in prostate cancer papers.
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After bicalutimide and a high testosterone level is pre treatment T just guess work?
Very low testosterone after ADT not rebounding after 8 months post treatment
