If testosterone is at castrate level, is hormone therapy useful in recurrent p. Cancer

My husband is due to see specialist on Mon and we have the latest results :

Psa = 1.5 (risen in short time from nadiir of 0.26)
Testosterone =14.

I looked up information regarding normal testosterone levels and anything below about 35 is considered castrate level.

Is hormone deprivation still given when there is little or no hormone to work on?

I am not sure I understand the significance of an already castrate level of testosterone and hormone therapy. Wouldnt my husband be condidered "castrate resistant" already , even though he has not had any hormone drugs for a few years?

What might be a likely scenario for discussion on Monday? I hate to use the term "castrate" in front of my husband as I do not want him to think he is any less a man than the randy bloke I married nearly 45 years ago. To me, he Still is that same man.

I try not to worry excessively and I almost convince myself that I am managing, but then, if this is the case, how come I am writing this post at 2.13am propped up in a dark bedroom tapping out words on a tablet?

Your assumptions seem on-track. Most prostate cancers eventually become "castration resistant," which means that they can continue to grow even when androgen levels in the body are extremely low or undetectable.

A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a man’s prostate cancer has become resistant to the hormone therapy that is currently being used. Time to discuss Plan B for 2nd line treatments.

yaamba,

Just a caution to verify the units of measurement and the normal range for testosterone levels. I seem to recall that you are in Australia which may, like Canada, use different units than the US for T measurements. I don't recall the actual units used here in Canada but the "normal" T range is something like 9 to 35 and castrate level is 0.5-0.9.

If your husband has not had hormone therapy since 2012 he should have had some T recovery and indeed would be in the normal range if your units were the same as Canadian units. Of course this could be completely off base, too.

All the best,

Yaamba,

I agree with your assessment that rising PSA with castration-levels of testosterone qualifies as "castration resistant." That means he can probably forgo getting shots of Lupron (or other GnRH agonists or antagonist).

This means that the cancer has evolved to use androgens other than testosterone, and can even make its own androgens. Because of this, there are second-line hormonal medicines that can help stop those things from happening.

As PDA said, sometimes casodex can block activation of the androgen receptor. A more powerful anti-androgen is Xtandi. Ketoconazole can stop androgen production by the adrenal glands. Zytiga can stop androgen production by the adrenal glands and from inside the cancer cells. There are several others in clinical trials.

As for the term "castration resistant"... They used to use the term "hormone resistant," but that implied that the cancer was resistant to all hormone therapy -- it wasn't. It was only resistant to chemical castration (chemically blocking the testes from producing testosterone) or physical castration (orchiectomy to remove the testicles). Even then, it is not totally resistant - any increase in testosterone levels will make the situation much worse.

I don't think a man is any less of a man if his testicles are removed (chemically or physically), any more than a woman is less of a woman if she has a hysterectomy. Of course it reduces libido, but I hope we are all defined by a lot more than just our sex drive.

I have always used the term "hormone therapy" when describing my suppressed testosterone, or sometimes the handy "ADT", androgen deprivation therapy. While it certainly is chemical castration, it's all too true that the term still bothers me. Before prostate cancer, honestly I'd never even heard of doing this to a person outside the context of a sexual abuser. The idea that it's a normal disease treatment rather blew my mind early on. I had a very hard time getting to the doctor for the first shot!

He may not like the term, even if it's applicable. I do understand that. It's not that I feel "less of a man", it's just a lifetime of negative associations with the term are hard to overcome.

If you wish to lower testosterone to the lowest possible level there is one sure-fire way to do that...Instead of chemical castration (lupron and its clones), actual castration.. it's cheaper than a single Lupron shot and it is far more effective..Then you can add the Casodex to neutralize the tiny bit of "T" remaining form other sources. When the cancer learns how to get around that, you move on to (if you are rich or you can get insurance company approval) Zytiga or Xtandi, which can push the finish line out another 2 or 3 years and in some men more than that....Maybe I'm laying this out a little too brusquely but those are the cards on the table...You gotta play the cards you are dealt....