Dear Pete and Swimom,
Pete, thanks so much for bringing this topic to the website. Swimom, I read your and your husband’s posts often over at the Low Blow forum, but I am new to the HealingWell one. Thank you for so much helpful information.
This testosterone thing is such a puzzle. This is what got me going on the PCa journey in the first place. I was overweight, depressed, and fatigued six or seven years ago (and still am), and, being in the health care field, I knew about male Men-opause, so I decided to ask my primary care doc to check the T-level. It came back around 200, so he gave me Androgel, but told me I needed to follow-up with regular PSAs and DREs-no problem, because I got these every year with my regular physical. Thyroid and other variables were okay.
Swim, you are right about the twins getting mad when their job was taken away and giving up working, because, once, I ran out of my prescription and by the time I got back to the doc, the T-level was 63 (my uro said that was castrate level)! Anyway, the last T-level before my diagnosis was in the 400s, but, at age 56, my PSA had gone from 2.9 to 4.4 in 14 months (red alert for a biopsy!). Scientific articles say testosterone replacement therapy can raise PSA, so I immediately stopped the Androgel and waited a month and a half to see if the PSA would go down, but made an appointment with my uro anyway. He reran the PSA and the T-level, but, before seeing them, scheduled me for a biopsy, anyway, because a PSA above 4.0 triggers that protocol.
Well, the discontinuation of the Androgel didn’t seem to do anything, except lower the T-level, because the PSA had gone from 4.4 to 5.7 in three months, and the free PSA percent was only 8. I thought I was hosed, but my doc said with no palpable lesion on digital exam, it may not be too bad. In fact, he even told me to start the Androgel again, because the T-level was 163. I said huhh? And he said, I don’t withdraw T unless the cancer is advanced. He said, if you came in here with a T-level of 400 (sort of normal), and stage T1c (which the biopsy indicated), I wouldn’t chemically or physically castrate you, so if you take Androgel which makes you come up to normal, that’s the same thing. Well, I didn’t do it because I was scared that I had a real aggressive cancer (Gleason 4+3=7, found by biopsy sample, but who knows what else was in there that didn’t get sampled), with the PSA going up 1.3 in three months. The final path report showed cancer on both sides (which the biopsy missed on the left side), contained within the gland, negative margins, lymph nodes, and seminal vesicles, with the worst Gleason in the gland (that they found) was still at 4+3=7. The first three-month post-op PSA was reported as <0.008, or undetectable, and the T-level was 195. Therefore, my uro wants me to go back on Androgel. I’m still hesitant, but I have read the scientific articles by Kaufman and Agarwal, and another doctor, A. Morgentaler of Harvard who is very outspoken about the disconnect between T therapy and PCa. The scientific debate can be observed by going to the National Library of Medicine website called Pub Med (www.ncbi.nlm.nih.gov/entrez) and searching for testosterone replacement and prostate cancer. So, I think I am going to try it, under close follow-up with an office partner of my uro, who subspecializes in uroendocrinology.
The goofiness of the relationship between T and PCa, but the support that therapy may be okay, follows several inconsistencies:
- As my uro said, my level is not normal, and he wouldn’t “ablate” my testosterone if it was, unless I had advanced cancer, which all indicators say is not there (thank God).
- There is scientific evidence that a percentage of hypogonadal men have traces of PCa anyway, and that their cancer may be more malignant than that in men with normal T. Morgentaler says this proves that low levels of circulating T are not protective against PCa. My primary care doc, when he was first prescribing the T for me, told me he had several patients who were hypogonadal but had prostate cancer. He may not have read the papers supporting this, or not snapped to the relationship. He told me he felt guilty about prescribing the T for me, but I thanked him for it, because the closer following of the PSA may have saved my life.
- Dr. Walsh’s book on surviving PCa notes that prostates, even with cancer, may put out a substance that somehow suppresses T secretion, because one study noted that after radical prostatectomy, there was an elevation in T-level in the men observed (I may have experienced this, because, while I didn’t have the T-level measured then, I got super-horny a few of weeks after surgery, but couldn’t do anything about because my doc advised me not to do anything sexual until 6 weeks after surgery. However, 3 months after surgery, the T was back to 195.)
- On the other hand, a Dr. Huggins found back in the early 1940s that, when he castrated (“orchiectomized”) PCa patients, their cancer regressed and survival lengthened, and this has served to establish the link between the two for over half a century.
- However, when guys get orchiectomized or chemically androgen suppressed, the regression effect lasts for a variable period, but maybe not forever, and then the cancer may come back and is called androgen-insensitive PCa.
Here, I think, lies the reconciling of the inconsistencies. The scientific debate says there must be two kinds of PCa cells, the hormone-sensitive and the hormone-insensitive. Giving testosterone will feed the hormone-sensitive ones and taking it away will starve them to death. Plus or minus testosterone does nothing to the bad bad guys. By process of survival of the fittest, if there is any cancer left after surgery or radiation, taking away the T will leave only the insensitive cells to take over. So, the T can be given and taken away anytime.
The benefits of T seem to me to outweigh what one may have no control over, anyway. We guys need T to protect our hearts; to avoid osteoporosis and broken bones, which can happen in men with low or no T; and to keep us from getting the low T syndrome—fat, sluggish, depressed, cognitively slowed, and with Mr. Happy not very happy.
Sorry for the LONG-winded post.
dj