My dilemma...

Met with my Uro yesterday after getting lab results back. PSA had dropped from .08 to .06 the past 90 days.

My big concern is testosterone. Reading was 146. I have been fatigued. loss of libido and inability to put on much weight. I'm 5'11" and weigh about 133 lbs. Uro was hesitant to put me on T therapy as he is afraid it might feed PCa. But he pointed out PCa could come back either way. He did mention some studies that showed no increase in PCa for those who choose T therapy.

I feel I'm caught between a rock and a hard place. The low T (and it's side effects) are causing problems on the home front. He did agree to give me a low dosage shot every two weeks if I wanted. I told him I would think about it and get back to him. He left the ball in my court.

Know I'm not the first to go through this and would appreciate and feedback, studies and personal experiences. This has really got me down.

Thanks to all!

Mpac1 - I don't have links handy to the studies, but I know Tall Allen does. Some of the recent research regarding the efficacy and safety of T therapy among PCa patients has been done by Dr. Abraham Morgentaler, in Boston. He is associated with Harvard, and some of his work has been published in their publications. He (and others) have published studies that tend to go against the common teachings based upon the 1941 "Huggins" study in which the researchers proclaimed that ". . . prescribing testosterone for a prostate cancer patient is like pouring gasoline onto a fire." This study, from 1941, is where much of the resistance to TRT for PCa patients comes from.

He (and others) have, in small scale studies, also proven that their Saturation Theory holds true, meaning that unless your T level is at or below castrate levels (usually cited as 20-50 whataver the units are), prostate tissue and PCa tissue will do whatever they usually do (grow, etc.). In other words, if your T level is 146 or 1460, the impact on your prostate and your prostate cancer will be the same. As long as those cells have enough T (over about 30-50), they may as well have all you want to give them. It is only when you reduce T to castrate levels that prostate tissue and cancer cells shrink.

Dr. Morgentaler's opinion also is that prostate tissue and prostate cancer tissue are unable to differentiate between testosterone produced in your body or testosterone bought at the pharmacy. Dr. M's opinion is that unless you have advanced or aggressive PCa, there is really no reason to not maintain a normal serum testosterone level.

You can search for research papers authored by Dr. Morgentaler, or look for papers on the Saturation Theory. You can also arrange for a consultation with Dr. Morgentaler (fees apply) by phone or in person. He may be willing to work with your local urologist or specialist to manage your care.

Please note -- I am in no way affiliated with Dr. Morgentaler. I have been a patient of his and appreciate his detailed, objective and most professional research into this topic that is so troublesome for PCa patients.

(Note to moderators - If I have over-stepped the bounds of forum protocol here, please feel free to edit or delete.)

P.S. Mpac1 - If you want to take this "off-line" just say so, and I will email you.

Possibly, but IMHO you will get the same response from the endo you are getting from the uro. When I was in agony about what to do with my TRT during and after RT for PCa, nobody I found was even willing to discuss it (and I'm near Chicago - not a small town). Eventually, with advice from Tall Allen and a strong suggestion from a highly regarded RO at Memorial Sloan Kettering, I went to Boston to see Dr. Morgentaler.

We'll see how it all works out, but I've maintained my TRT through the RT and now after. Unless I have some anomalous PSA readings, I will continue it for the foreseeable future.

Mpac1

You've had a positive surgical margin and your uPSA pattern is trending upwards (with a single minor fluctuation). I think the decision you are facing is not TRT, it is SRT (salvage radiation therapy). Fortunately, the margin was GS3+3, which probably means it will be some time, hopefully years, before it progresses to a metastatic/incurable stage. But isn't that something you want to jump on sooner rather than later? Your low T is actually a benefit in that it may slow down its progression. If the SRT is successful, you can always consider TRT then.

Paxton said " In other words, if your T level is 146 or 1460, the impact on your prostate and your prostate cancer will be the same" so why would his low T be a benefit in slowing down the progression?

I'm with TA on this one. After all you've been through, why take chances?

Unless, of course, your wife is 30 yrs younger than you. In which case, no worries, you'll probably die of a heart attack first. lol

Mpac1 said...
...My big concern is testosterone. Reading was 146. I have been fatigued. loss of libido and inability to put on much weight. ...

I'm wondering why your T is so low, are you on hormone therapy? I can certainly commiserate with your low T issues after being on Lupron - that was a miserable few months.

Can't get it to change on my signature, but I'm 73 now. DX at 71.