Morgentaler reflects on Testosterone and PCa

This Morgentaler guy has good skill for self promotion, but he also appears to have a solid scientific career to back himself up. It would seem that his interests aren’t so much with guys who have advanced prostate cancer. I wonder if he would advise men on ADT to drop the drug, and maybe even start using TRT? If not, why not? Does that scenario fall outside of his TRT beliefs?

I can just see some patient giving his MO the middle finger and dumping his combination therapy for T shots.

Hi slapshot. I, too, have no dog in this fight. However, Morgentaler says

"Second, there has been an incorrect assumption that ever-greater androgen concentrations lead to ever-greater PCa growth, whereas it has been shown that the prostate's requirement for androgens appears fully satisfied at a relatively low T concentration of approximately 250 ng/dl, presumably due to saturation of androgen binding to the androgen receptor."

Isn't his point either use ADT to get T concentration very low (say <50 ng/dL), or, if you're not doing ADT therapy, don't worry so much about supplementing T if you need to. I don't think he is saying ADT doesn't work (but yes, there has been increased focused on its negative effects).

Djin

First, let me acknowledge that I have been a patient of Dr. Morgentaler. Then, I should also acknowledge that I have been using TRT for about 15 years (before, during and after PCa) due to symptomatic adult-onset hypogonadism.

That said, I think many readers are trying to find a "one size fits all" summary from the articles about Dr. M's work. I don't think there will be one of those.

I personally think that the use of TRT among PCa patients needs to be considered on a case by case basis. Sorry, but that's just how it is (IMHO).

A "favorable intermediate risk" PCa case, which might be a G3+4=7 with low tumor load and low percentage of G4 cells at biopsy (such as my own) is a far different risk profile than another G7 case who has large tumor load and/or higher G4 content. My own take is that TRT should be a valid consideration IF that patient WOULD NOT, in the standard of care, receive ADT treatment. My reasoning is that if a patient who is hypogonadal needs TRT, and who would not require ADT for PCa, why on earth would I (presumable the doctor) deny that patient a normal T level just because of some other unrelated bodily malfunction? The patient's body (and their PCa) cannot tell the difference between the T that his body might (or might not) produce and that which he purchases as the local pharmacy. It is the same stuff, and as long as the target T level is within the normal range, there is no added risk to the PCa prognosis. (If there was, why wouldn't we castrate ALL PCa patients?)

Where things become murky, though, is where the patient's PCa pathology is more severe than "favorable intermediate risk" - and that is where the patient and their care team need to do their homework.

I am not trying to start any sort of debate here, but I am trying to clarify that there are different cases for TRT in PCa patients, and some are easier choices to make than others. There is no "golden rule" regarding the use of TRT in PCa patients.

All this is my personal feeling/opinion. I am not a doctor, nor do I play one on TV. I am just a PCa patient who has had the benefit of long-term TRT as well.

Oh, and BTW, read the notes in the article regarding the original Huggins study that concluded T was contra-indicated for PCa patients. That study actually only started with a cohort of 3 members, and only ONE completed the study. These days that would not qualify as a research study. It would be an anecdote, perhaps not even worthy of forming a working research hypothesis.

I tried going off TRT when I was diagnosed and after nine or ten months off my testosterone was 25 and dropping.
I found a old clinic and got back on TRT and yes I withheld the PCA diagnosis.
So I've been on TRT throughout. I'm Three years past SBRT with PSA of .06
I just couldn't stand the emotions of low testosterone. Crying sad, anxiety and depression are the trump cards that made my decision easy.
Lucky I was not high grade but I don't know what I would do even if higher grade PCA

Glen