Testosterone

Congratulations on your non recurrence. I'm sure TA will be able to answer your question soon.

I'll be watching this thread, too. I haven't been treated yet, but since I've been on T supplement for 3 1/2 years prior to diagnosis, I'll be looking for guidance about possibly going back on it later. I'm favoring radiation thus far, though, so I will probably need to wait longer to "prove" stability/cure after treatment.

I am interested, though, in staying current with research about T replacement after PCa treatment.

I was on TRT for a couple years before diagnosis, and after a very reassuring post-op pathology report, I resumed TRT six months after surgery. It's been 2 years now, and my PSA remains undetectable.

My lowest recorded PSA level was undetectable on a super-sensitive assay (<0.03), and I now get tested on the regular assay. I did have one test right at 0.1, but the next two were undetectable, so my urologist isn't worried about that one test result.

It makes such a difference in my QOL that I can't imagine not having it available to me. This included using it through diagnosis and treatment of a much more serious cancer that has required two surgeries and chemo. My oncologists thought it was fine to stay on the TRT, hoping that it would help me to remain strong throughout my treatments for the other cancer.

I use testosterone enanthate, administered by self-injection.

Many urologists (including my own) now consider testosterone replacement therapy (TRT) safe after radical treatment for prostate cancer. Usually what they look for is a history of undetectable PSAs (after surgery) or low, stable PSAs (after radiation).This is based on a few small studies. Unfortunately, there will probably never be large randomized clinical trials to absolutely, definitively prove it. Men who have been cured should be supervised cautiously when taking TRT.

The latest I've seen is the following, but it is based on only 105 patients. They conclude: "Thus, testosterone therapy is effective and, while followed by an increase in prostate specific antigen, does not appear to increase cancer recurrence rates, even in men with high risk prostate cancer. "

Testosterone Replacement Therapy in Patients with Prostate Cancer After Radical Prostatectomy

This one was based on 82 men who had a variety of PC therapies. They conclude: "our study supports the hypothesis that testosterone therapy may be oncologically safe in hypogonadal men after definitive treatment or in those on active surveillance for prostate cancer."

Testosterone Therapy in Patients with Treated and Untreated Prostate Cancer: Impact on Oncologic Outcomes

BTW- Putting aside considerations about prostate cancer for the moment... There is no optimal level of T, so it does not matter what your current T level is, even if it is above average. If your libido is low, and you can rule out psychogenic causes, it is reasonable to supplement T to see if it will work. But whether you can get an Rx for TRT without a diagnosis of low T is another matter.

Thanks, Allen and Bob. It seems clear that I am in for an "interesting" journey over the near future, with needing to abandon the T during and (at least for a while) after treatment. I'm not looking forward to the likely "crash and burn" that happens when T is stopped after long term supplementation. I'm trying to get to the point of acceptance of the inevitable though, at least for a couple of years until we see where my PSA goes post RT.

At the moment, the best plan appears to be to do what I must, complete treatment, and monitor PSA until we see when/where I reach nadir. At that time I will be able to re-open the discussion of T supplement with my uro. I just hope I can maintain health and sanity until then, and I will need to keep an extra careful watch on both.

I hear you, TA, but from what we know of my diagnosis/pathology so far, my PC would not ordinarily call for ADT. I'm just ticked that I am to be forced to endure almost all of the side effects of ADT without the medical benefit of ADT itself. If my T level drops to castrate level, then maybe I'd be in your group member's situation, whether I needed that level of ADT or not. Still not happy about it, though, but it is what it is.

I'm meeting with one RO this coming week and a second the next week, so I hope to hear their ideas for treatment plans for me, including how to handle the T. I'm planning to ask if it is possible to ramp down my dosage to try for a "soft landing" rather than a crash. I'll also ask if they have any thoughts on clomid/HCG or any other medical means to try to re-start endogenous T production to try to mitigate the SE's.

I understand, Tybeeman, but if I choose radiation rather than surgery, I could have an extended period before I reach nadir. I know they will likely want to wait to see stable results post treatment, so I may have to exist in "low-T hell" for an extended period of time. At my age (almost 69), by the time they are willing to re-start external T, I may no longer care.

I hear you about choosing surgery, Tybeeman. I just can't bring myself to choose surgery after open-heart surgery, two hernias, two other heart procedures. . . just been cut open too much and I fear the stress on my body from recovery may be more than I can deal with. Of course, I don't know what stress a year or three of low-T will do to me. That's part of why I'm so angry about this. Only those who've been here (PCa and low-T) can understand it.