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Low T therapy after RP

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Posted 5/24/2012 12:26 PM (GMT 0)
There is still lots of hype about low T therapy for those of us who have been treated for PCa.  Below is an interesting study regarding this issue.  In my opinion the jury is still out on low T therapy for guys like me. 

METHODS: All hypogonadal men who were treated with TRT by members of

our department following RP were retrospectively reviewed. PSA values

before RP, after RP, and after TRT were evaluated. Serum testosterone

levels before and after TRT were also examined. Only patients with

undetectable PSA values and negative surgical margins on pathologic

specimen were offered TRT and included in the study.

MAIN OUTCOME MEASURES: Main outcome measures were changes in PSA and testosterone values after initiation of TRT.

RESULTS: Fifty-seven men, ages 53-83 years (mean 64), were identified

as having initiated TRT following RP. Men received TRT for an average

of 36 months following RP (range 1-136 months). Patients were followed

an average of 13 months after initiation of TRT (range 1-99 months).

The mean testosterone values rose from 255 ng/dL before TRT to 459

ng/dL after TRT (P < 0.001).

There was no increase in PSA values after initiation of TRT and thus

no patient had a biochemical PSA recurrence.

CONCLUSION: TRT is effective in improving testosterone levels, without

increasing PSA values, in hypogonadal men who have undergone RP.

http://www.ustoowichita.org/pdf/TESTOSTERONE%20REPLACEMENT%20THERAPY.pdf
Posted 5/24/2012 3:11 PM (GMT 0)
Here is a working link

tinyurl.com/nsu63p

My opinion after reading this article is that TRT may be safe if you do not have PCa. I don't think many doctors would offer TRT unless you have had a stable PSA for several years and while not undergoing HT. Quality of life plays into the choice, so perhasp if you are really suffering under low T, doctors may choose TRT.

-Winter
Posted 5/24/2012 4:31 PM (GMT 0)
Thanks for providing a workable link.  The article is interesting and brings to light some Urologist are using Androgel for their post op PCa men.  There are just as many low T guys get PCa than those with normal levels. Once the cancer is undetectable for a year or more low T therapy may be good for some who really need it.  Personally, I'm not sure whether I would want to take a chance even though my T level is somewhat low.   
Posted 5/27/2012 9:15 PM (GMT 0)
In reading the article, I find it interesting that my symptoms of low T are what brought me to my GP, and he ultimately ended up doing a PSA test which found the cancer. What if it was the reduced T that actually helped bring on the PCa? Absolute speculation, admittedly. I had always wondered if the low T was a reaction to the PCa, which my doc denied. What if it was the reverse?

After my PSA was <0.1 for over a year, I supplemented until I had a recurrence at something over 18 months (however, I was having the less sensitive test (one place after the decimal), so I don't know if it was slowly rising for awhile). I stopped as soon as the PSA was detectable again. After SRT and a clear (<0.1) PSA for over a year, I am now back on TRT - but only to reach normal levels (500 as a goal). I feel that I may be taking a risk, but to me the symptoms of low T are worth getting to normal levels. Part of it is that I don't want to live my life in fear, with the philosophy that it is going to recur. Part of it is that most men that are in my boat have normal T levels, so I am only putting myself as "at risk" as those guys are.

It will be interesting to see what more research shows regarding this topic - but it is interesting to see that there were many that had a different interpretation to begin with.
Jeff
Posted 5/27/2012 10:58 PM (GMT 0)
What would you guys have to say about a "brother" PCA survivor having a testorone level of 234 and no ability to have "normal" relations wirth his wife...is it worth the risk to increase the T level back to normal knowing that the cancer may be lying in wait for me again!?
Posted 5/27/2012 11:35 PM (GMT 0)
Well that is the 64 thousand dollar question, isn't it?

    I am currently doing just that although for different reasons. I can have sex with my wife using trimix, but I don't really want to, I have no drive. I am more interested in treating my osteopenia (early osteoporosis) which I found out about 2 years ago when I discovered I had low T and my depression which has definately worsened over the past few years. I got 4 opinions on the T issue: My internist was against it, my operating urological surgeon, local urologist, and now endocrinologist are all for it. I don't want to look like the hunchback of Notre Dame 20 years from now, I've seen the pain these people with no spinal bone live with. That's why I'm trying it. The way my endocrinologist put it, "testosterone doesn't cause prostate cancer, it will just make it show up sooner if there are some dormant prostate cancer cells still there." How much sooner he didn't say but he gave me the impression the prostate cancer was coming back sooner or later if it was still there regardless of T. So I've had 0 psas for almost 4 years, and my serum T is in the 200-300 range, and my free T is in the abnormally low range. And I don't feel good, so I'm gonna try T for a few months...

Posted 5/28/2012 12:46 AM (GMT 0)
ICECAT, being that I am in a similar situation as you, I think you already know my answer (although it is just the answer I have for myself - I think each of us needs to make up his own mind on the subject). My GP is completely against TRT after PCa, and has let me know that. My surgeon is in favor of getting me to normal levels (500) one year past undetectable PSA. She will take me off it if I have a BCR. I like having a normal libido (my wife does also, but she won't leave me if it goes away). I am also concerned about osteo issues like mspt98 mentioned.

mspt, I hope you feel better. I did (T is between 100 and 200 without TRT).
All my best
Jeff
Posted 5/28/2012 5:09 PM (GMT 0)
Prostatectomy in 2002. T1c, confined to prostate, no signs of SV or lymph involvement, Gleason 3+3=6, PSA of <0.05 since. T was 247... and I was having ALL the issues of low T. Started back on TRT July 2011... March 2012, T level at 658....PSA read 0.12. May 2012, PSA 0.12. For now, no more TRT.... and will watch to see what PSA does. Anyone out there who has resumed TRT and had a similar rise... followed by a drop again?? I had consulted with uros and endos... and they thought it was *safe* for me to try the TRT as it had been so long and my numbers in post op path had been so good. Maybe I made a mistake?? I'm in panic mode! :-(
Posted 5/28/2012 5:36 PM (GMT 0)
Franglais, no change in my PSA reading so far - it has hovered between .03 and .07 and is usually .05 or .06. I believe that the variation is in the "noise". I hope that the increase for you is inconsequential. Many doctors consider anything below 0.2 as not being a recurrence. My doc would probably take me off the T if I hit 0.12 as well, at least long enough to figure out whether there is any movement.
Jeff
Posted 5/29/2012 2:06 AM (GMT 0)
Franglais,

I would definitely quit Low T therapy if any increase in PSA was observed. Particulary since you had the prostate removed.
Posted 5/29/2012 7:58 PM (GMT 0)
Gibson, I'll be curious to hear what an endocrinologist has to say - I have debated about seeing one before.

Good for you getting PSA testing started at your age for baselining (IMHO).

You are right - who knows? I figure without better evidence, I'd just as soon get to normal levels. By the way, just based on libido, I believe that my levels were normal and then dropped off when I was about 47. Initially when it dropped, it was sort of a blessing, because it made my wife and my libidos more in line. But it was the rest of the symptoms that finally got me to my GP - the low energy, etc, and I was lucky that he ran a PSA.
Jeff
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