Now it’s my time to sweat it I suppose

I can’t believe I’m actually ending up posting here for information on detectable PSA since I was one of those overtreated Gleason 6s whose PSA went to undetectable after surgery 11 years ago. I just found out that my annual PSA came in at .05. After seeing the post on the man in his 70s and your opinions on his options I wonder if there is anything else you can add. Many of those years of undetectable PSA were with the old test that registered at <.1 but the last few years was at the .00 scale. This test also was done this year by the urologist not the endocrinologist who converted to the .00 scale for the first time. Again I was told by urologist the past 2 years it was psa <.1
As you can see below I was Gleason 6+6 in 2 cores on right , < 5 and <15% respectively. Should I stop TRT which is maintaining my T levels in low normal range? I use to think guys with small upticks in psa were overreacting, I’m not sure anymore, repeat psa in 6 months?

mspt98 said...
Should I stop TRT which is maintaining my T levels in low normal range?

First, a confirmatory uPSA in the next month or so would be good. Your .05 all of a sudden seems unusual.

That aside...this is a tough one, because if you are only in low normal T range *with* TRT, then won't you go way down almost into castrate T range *without* TRT? And that will be tough to take.

Morgentaler's saturation theory says that PSA is exquisitely sensitive to T levels in the castrate range, but not at all above that range. So I guess if you did stop TRT, within a few months you would probably see your PSA stabilize or start down. If during that time, your uPSAs still trended up fast, you should probably start talking to a good RO and making plans. You should run all this by your doc.

I can tell you what has happened with me, twice, though it does not follow the "theory". While on T-cyp injections, my uPSA rose to .05 in Dec. I stopped the shots, and my monthly uPSAs started falling and have leveled at .036, .035 and .035 the last three months. I did this type of "trial" in 2017, too, with same results.

Here is my chart:

https://imgur.com/vaqv1hh

I have run across a couple other guys on different PCa boards that seem to have the same response as I have. We are all left wondering "what's going on?"

Might run it by your doctor. But, yeah, if you really are now in the .05 range, I would stop the TRT for a few months, maybe three or four, and watch your uPSAs at monthly intervals. But that's just the opinion of a non-medical person in the same boat as you.

For me, though, I am at the point of being too scared to continue TRT. Forever, I guess.

Robert

Another question -- even if the T is moving your PSA up to a detectable level, why stop the T? You would have to get your T down to somewhere less than 20 ng/Mmol (right measure?) in order for it to be effective. Your body might still produce that much T, and if it did, your cessation of the external T would be for naught.

Another way to look at it is that you don't need to stop your external T unless your PCa gets to a point where ADT is standard of care. Until then, neither your body nor your PCa can tell the difference between the T made by your body and that which you buy at the pharmacy.