When should I start HT

Consider a retest to confirm. Also, make sure you are getting a ultra sensitive test and not a standard which only goes down to .1

I must have talked to a half dozen excellent medical oncologists about this and opinions vary. All agree that there are 3 situations that require immediate HT:
1. high PSA (>10 ng/ml), or
2. rapid doubling time (<9 months), or
3. detected metastases or symptoms

Some have incorporated the findings of the TOAD RCT into their practice and use ADT when recurrence after salvage RT (>0.2) is confirmed, while others wait for one of the above 3 events to occur. The ones who discount the TOAD findings argue that 5 years f/u is too short and and the study was underpowered. The ones who go with TOAD point to the fact that quality of life was not impaired by the earlier start, and time to castration resistance was not shortened by it -- so there may be an advantage and there does not seem to be any disadvantage.

www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)00107-8/abstract

None that I have spoken to would begin ADT at only 0.1. I hope you're discussiing this with a medical oncologist.

Thank you Very Much guys. I truly appreciate your quick response.

Ak
I'm in a similar situation. For now my RO is more inclined to make a decision when to start ADT based on doubling time rather than an absolute psa number.

As for how long ADT will work I believe the average time from BCR (determined by a psa reading of 0.2 or more) until detectable mets is about 8 years. After ADT eventually fails there are now many other treatments than in the past that can buy us another 5 years or more.
Jim

Ak123-

One of the more interesting learnings from the TOAD RCT was that castration resistance set in earlier among men who delayed the start of HT. It had been thought that HT drives selection of hormone-resistant cancer. While that may be somewhat true, the effect of getting rid of so many cancer cells with HT has a much bigger effect.

Median survival after SRT was 13 years early in this century. It's undoubtedly much longer now.

Thanks Tall Allen
My understanding now is that you are not going to start HT now becuse you are at .1 and if god forbid, yours reaches .2, you might consider it?

There is no reason to stop lifting weights. If your testosterone level is normal, lifting weights will not affect disease progression.

I am not recurrent. I go along with other patients on doctor visits.

Allen - My husband had surgery and then salvage radiation about 8 months later when PSA was up to .17 or so. PSA rose after a couple of years to .2 but has remained between .25 and .35 for the last 3 years, fluctuating up and down, usually .28 - .32. Are you saying that some oncologists would recommend ADT now instead of waiting? I'm curious as we are meeting with his oncologist in a couple of weeks and I'm wondering if it is something I should be asking.
Also - Ak123 - you might ask your doctor if they would let you try metformin. Completely anecdotal, but my husband's PSA has remained stable since he began taking it. Studies are still inconclusive as far as I know.

Melg, thanks for your response. I had heard that metformin is good for patients who are on HT becuse it minimizes the side effects of HT as per Dr. Myers. Does your husband takes it because he has pre diabetes or just takes it strictly and only to control the PSA?

AK - he takes metformin strictly because of prostate cancer and has not gone to ADT yet. He is young and healthy except, of course, for the prostate cancer. The doctor wasn't opposed to it as it has little downside and maybe an upside.

AK
Positive margins and ECE are not good signs particularly if SRT hasn’t worked. I see no reason for delaying HT and it’s been my experience that Lupron or its equivalent plus casodex and dutasteride should be employed.
Bob

I am trying to make sense of this because based on what Allen’s doctors said, they would not start unless in these 3 conditions which I don’t have as of now and as long as the delaying it will not shorten the time to casteration resistance so why the rush now and not wait untill psa reaches 3 or 4? I would rather go with metformin for a couple of years or so if it will slow the psa down. This approach makes more sense to me unless I am missing something important and I don’t see it. Thanks all for your input.