testosterone and relapse?

Hello all,

  I am new to the forum and would like to know if anyone has relapsed after

receiving testosteone for low t. I am almost 2 years out with a gleason score of 6 before and after rpt.

0.1 on all psa tests but t is only 189. Would like to start t but am terrified it will trigger

a relapse. onc. says min of three years of 0.1 then we can talk about it.

I'm only 47 but feel wiped out by 10 in the morn. severe depression and almost no libido.

No incontinence and no problems with ed.

Thanks in advance for any feedback

carp

rp

r-4-27-11 

hahnemann hosp in philly

gl. 6  before and after surgery

WELCOME to the forum carpe ! I dont know but I can tell you about my experience. I went for a physical and had bloodwork drawn. The Dr. told me I had low T and put me on testostrone patches for three months. I was feeling better, but I started urinating more frequently. I went back for a checkup, did a repeat bloodwork testing my PSA for the first time and it was 6.6, he told me to get off the patches immediately and go get an ultrasound to make sure everything was ok. Well, that turned into a biopsy and then my news I had pc. I would have not known about my pc at all and would have not gotton a PSA test probably until years later. Those testostrone patches triggered the pc enough to give me symptoms.

Carpe, give Dr. Bazzan at Jefferson a call.  He can help you out with TRT post surgery.  Start the process now as it takes months to get an initial appointment. 

Paul has been on testosterone replacement threapy since shortly before he was diagnosed with a Gleason 6, PCa in 2005 at the age of 48. In fact it was T therapy that surfaced an indolent cancer sooner than he would have otherwise been tested. Less than a year post-op he started back on gels, then shots, and he's been free of lowT symptoms / PCa ever since. Yep, the (almost 8 year mark) latest PSA is another "0".

The whole testosterone thing becomes a quality of life matter for each man to consider for himself . I think of it as either a curse or a blessing. In Paul's case, he'll be dancing at our daughter's wedding in June thanks to early detection and a good care team.

Good Luck and stay well!

Swim

I have been on testosterone replacement therapy for approximately 10 years. I had prostate surgery in 2010 and both my surgeon and endocrinologist gave me the green light to continue. So far all of my PSA tests have been undetectable.

I wonder what actions, if any,would your doctor take if your testosterone level was naturally around 500. If testosterone is seen as an issue would some effort be taken to reduce that level?

I'm not sure what was unclear. TRT has never been shown to cause PC to recur after the PC was cured with a prostatectomy, so as far as we know, it's safe. Low testosterone, on the other hand, may be hazardous to one's health and well-being. How's the TRT working for you so far?

I think they made the erroneous reasoning from symmetry: if taking away all testosterone was good for PC (it slowed it down), then they suspected that adding testosterone must be bad for PC (it ought to speed it up). As it turned out, they were wrong. Dr. Abe Morgentaler and others now espouse "saturation theory." The prostate cancer is like a sponge and testosterone is like water -- once the sponge is completely wet/saturated, adding more water won't make it any wetter. According to saturation theory only two states are important to prostate cancer -- it's either testosterone depleted (as from ADT or castration) or it's not.

In fact, there seems to be a link between naturally low testosterone levels (=hypogonadalism) and higher incidence and more aggressive prostate cancer. It's hard to say whether the low testosterone causes the PC, or whether there is some genetic or environmental co-factor that causes both. There is some evidence that normal testosterone levels may help keep healthy prostate tissue healthy, perhaps by encouraging normal rates of cell differentiation.

My doctors (at UCLA) both agreed to give me TRT after my PSA stabilized. Because I had RT, the question for me wasn't that testosterone might cause a recurrence, but that it might cause my PSA readings to fluctuate in an unpredictable way (perhaps by aggravating BPH), thus interfering with my ability to know if my RT was effective. If I'd had RP and had undetectable levels of PSA for a year, they would have given me TRT immediately. I think many urologists have changed their point of view on this already. Now if only the pharmaceutical companies would take the PC warning out of their advertising, contraindications and package inserts! It's amazing to me that they can say that with absolutely no evidence to back it up.

Thanks to eveyone for  info on the subject of trt. Im coming up on two years so as long as my next test is 0.1, Im gonna push for trt.  I dont think a reading of under 200 every time I get tested for t is very healthy.

I was gle 6 and a psa of 4.2 at its highest so hopefully Im a good candidate for it.

Thanks again,

Carp  47 y.o from philly

Tall Allen, thanks for straightening me out. The TRT seems to help me sleep better, which in turn gives me more energy. Also, my joint pain seems to have diminished. When I go back in April I think we will up the replacement.

Carpe, I had the hardest time finding a Doctor in the Delaware Valley who would help me out. A Dr. from HUP never even returned my calls. Please try the Doctor from Jeff I mentioned earlier in this thread. I like him because he emphasizes diet and exercise.

This subject comes up a lot in my PC Support Group, so I've researched it well.

Postop asked: "Can anyone provide a link to any randomized trial of testosterone in patients with prostate cancer demonstrating that it does not cause tumor progression?"

The research I cited followed men for 3 years after they were treated for RP. Here are a few more that you might want to look at:

10 hypogonadal RP patients were given TRT. After a median of 19 months, none had PSA recurrence.
"TRT after primary treatment for PC"
Agarwal et al, J Urol 2005 Feb; 173(2):533-6

7 men received TRT post-RP with no biochemical recurrence.
"Androgen replacement after curative RP for PC in hypogonadal men"
Kaufman et al J Urol 2004 Sep; 172(3):920-2

31 men received TRT after prostate brachytherapy for a median of 4.5 years, and none experienced a recurrence.
“T replacement for hypogonadism after treatment of early PC with brachytherapy”
Sarosdy, Cancer 2007 Feb 1; 109(3):536-41

13 men received TRT post RT (brachy or XRT) for a median 6 years with no increases in PSA or biochemical recurrence.
“TRT in the setting of PC treated with radiation”
Pastuszak et al (Baylor) Int J Impotence Research 2013; 25,24-28

96 patients from 2000 to 2007 received TRT after initial treatment for PC. While most men in this series had increasing PSA levels during TRT, stopping TRT typically reversed it.
“T replacement in PC survivors with hypogonadal symptoms”
Liebowitz, et al (USC) BJU Int. 2010 May; 105(10):1397-401

They are all small studies. To definitively determine safety of TRT post-treatment would require a controlled study of 6000 men, by one estimation. This is not likely to ever happen.

But your question was about TRT treatment in men "with prostate cancer," rather than those who had been cured. There is one uncontrolled small study that I am aware of, by Morgentaler, in which T was given to men with known untreated PC. In this remarkable study, 13 men with known PC (12 with Gleason 6, 1 Gleason 7) were given T. On the average, there were two follow-up biopsies after a median of 2.5 years. Amazingly, no cancer was found in more than half the f/u biopsies. Two men showed higher grade on initial f/u biopsy, but was not confirmed by a second f/u biopsy in one case or by RP in one case. No PC progression or distant disease was observed:
“T therapy in men with untreated prostate cancer” Morgentaler et al.
J Urol 2011 Apr; 185(4):1256-60

Postop stated: "so it is logical to assume the hormones accelerate tumor growth."

As I said, that's a "fuel to the fire" argument based on symmetry, and it does not necessarily follow logically. The saturation theory has more proof behind it.

Research has consistently failed to find an association between endogenous testosterone (T) levels and risk of PC development, and I think that most authorities would agree that T does not cause PC. This has been substantiated by many prospective controlled research studies. For example:

In a very highly regarded and oft-quoted study, data from 18 worldwide prospective studies were pooled in this analysis of 3886 men with PC and 6438 controls. They found that serum concentrations of sex hormones were not associated with the risk of PC:
"Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies"
J Natl Cancer Inst. 2008 Feb 6; 100(3): 170-83

In a recent study of 1,365 men followed for up to 20 years while they were on testosterone replacement therapy (TRT), they found that initiating testosterone treatment had no statistically significant effect on total PSA, free PSA or free/total PSA ratio, and any initial PSA change had no predictive relationship to subsequent diagnosis of cancer.
"Is Testosterone Treatment Good for the Prostate? Study of Safety during Long-Term Treatment." Feneley and Carruthers, J. of Sexual Medicine, June 6, 2012.

In this interesting research, they examined frozen serum samples of 166 men who were originally cancer free but were diagnosed with PC 24 years later and found no association between serum T levels and later PC development.
"Serum T and SHBG concentrations and the risk of PC: a longitudinal study"
Heikkila et al, Cancer 1999 Jul 15; 86(2):312-5

Another tissue study with 727 PC cases and 889 matched controls found PC risk was unrelated to serum T:
"Endogenous sex hormones and the risk of prostate cancer: a prospective study"
Weiss et al. (Natl Cancer Inst, NIH) , Int J Cancer 2008 May 15;122(10):2345-50

In a small randomized double-blind placebo controlled study, researchers at UCLA found that TRT raised T serum levels but had little effect on T prostatic tissue levels. They found no association between T levels and PC incidence. (Researchers at UW-Seattle found this to be true of DHT as well).
"Effect of TRT on prostate tissue in men with late-onset hypogonadism."
Marks et al, JAMA July 6, 2011(306:1)

Postop stated: "it's in the ads because it is required by the FDA."

I agree. The FDA should be basing their requirements on evidence, not conjecture.

The last words have not been spoken on estrogen and breast cancer yet -- most recently, estrogen alone has been shown to decrease the risk of breast cancer, but when combined with progestins, increases the risk. But that is not relevant to this forum. To answer your question, estrogen is not testosterone, and breast cancer is not prostate cancer.

Another very interesting subject to me is the role of estrogen in prostate cancer. The short answer is that it's highly complex- both an agonist and an antagonist. But I'll leave that for another thread.

Here is a link on estrogens and breast cancer:

www.sciencedaily.com/releases/2007/04/070418182417.htm

I'm not sure of your points. The point of posting the meta-analysis on randomized control trials of testosterone supplementation is that there is a reasonable concern that testosterone might have adverse effects on prostate health. Grouped measures of prostate health were increased in the patients receiving testosterone compared to placebo; this was statistically significant. This isn't the same as a single well designed trial that measures effects of a standard testosterone dose on PSA and prostate cancer over several years of observation. Until such a definitive randomized control study is done, it is wrong to say that it is proven to be safe. Its safety, or danger remains unknown.

The article on estrogen isn't a trial, it's just an article reporting the observation that breast cancer rates in the general population of post-menopausal women dropped dramatically after doctors stopped prescribing hormone replacement therapy in 2002. It is true that the Woman's Health Initiative trial itself demonstrated increased breast cancer in the estrogen + progesterone arm but not the estrogen arm, but because of other health issues either type of HRT is not recommended.

The story of HRT is that it (estrogen alone or estrogen + progesterone) was heavily promoted as safe and beneficial for decades and decades based on many, many more studies than exist for testosterone supplementation in men. Millions and millions of women were given it, including my mother, and wife and probably yours, too. The majority of the postmetopausal women in the US and many other countries got HRT for many decades, based on inadequate science. Only when the effort was made to perform a definitive trial was it proven that it was bad for them. Should we repeat this experiment in men?