Testosterone replacement therapy after RALP

I had a bone density scan last week. Dr. Mulhall ordered the test because my testosterone level jumps around from low-normal to normal - and guys with low testosterone can develop osteoporosis.

The results of the scan aren't great. My bone density is at the absolute bottom of the "normal range" using one measure (Z score) and in the osteopena bordering on osteoporosis range in another measure (T score).

Treatment for osteoporosis in guys with low testosterone is usually some form of testosterone replacement therapy.

Since PCa cells "feed" on testosterone, I'm quite uneasy with adding extra testosterone to my body. Even with my good pathology report and consistent zero PSA scores (14 months, thus far), I'm concerned about testosterone replacement therapy accelerating any possible return of detectable PCa.

Does anyone here have experience with Testosterone replacement therapy after successful treatment of PCa?

[ Ok, I'll vent a bit too... I'm also pretty annoyed at my health. I'm 42 years old, for crying out loud. I have health issues like PCa, ED, and bone density loss that typically occur in guys twice my age. I feel like I "deserve" better for living a life of consistently excellent diet/exercise and taking great care of my body generally. Grrrrr. ]

-Gedman

Hi - I have been lurking for a while, but I am on TRT after removal of my prostate. The RALP was performed in December, 2009 (I was Gleason 6, with 5 of 10 cores positive, with up to 30% of one core being cancer cells, and it was bilateral). After surgery, with negative margins, I have been fortunate to have less than 0.1 PSA readings, starting 6 weeks after surgery, and now consistently through 4.5 years. about 1.5 years ago my T level was determined to be low (about 215), and my primary doc, in consultation with the uro, felt that T injections would be appropriate. They have helped me tremendously (in terms of energy, primarily), and for the 1.5 years I have been on the T my PSA level did not increase. Best of luck to you with whatever you decide to do.

Gedman,

    I did the Testopel thing 04/05/2014. No rise in PSA. Figured since I was on the supliment I'd start working out more. Using weights everyday have lost a few #'s probably tripled my strength in 3 month's. So far so good.

 

If my PSA is still undetectable on 7/14 (19 days and counting), my surgeon has agreed that I can return to taking T at the 6 month mark after surgery. My post-op pathology was about as good as possible (tumor amount was 10% of prostate, and there was one focus of Grade 4 that made up 5% of the tumor - about 0.5% of the prostate). My surgeon and endocrinologist usually both prefer 1 year, but both have agreed that 6 months seems fine in my case. And, given the saturation theory, I don't think there is any additional risk at all. My natural levels are low, but not low enough to fall into the sub-saturation levels.

Thanks for the input, folks. I'll be speaking with Dr. Mulhall in a few weeks about what to do next regarding my inconsistent testosterone level and (apparently) early osteoporosis.

-Gedman

Gedman,
My journey really closely resembles NY-Sooner. Fatigue gone but libido best controlled by Cialis. I can say I am very happy that I can even have an erection and testosterone replacement therapy after years of treatment for advanced prostate cancer.

Ha, but I had my 52nd birthday last Thursday. Almost 8 years after my start with PCa. In a durable remission. I'm good with it.

Time to load up another underarm shot. And wax the Camaro.

I take an aromatase inhibitor when on T. I also do injections rather than gels and my doc wants my total T in the 600-900 range. He says that gels rarely get people there and he finds that the full benefits of T aren't realized until the numbers get into that range. I'm not crazy about the injections, but I felt so good with my T levels in that higher range. Fifteen days until I have my next PSA test and I find out if I can resume the TRT.

Bob - You will likely get many vastly differing opinions on the T question, but bear in mind that these are usually only opinions - unless they are accompanied by valid research publications. That said, you should do a web search for the work of Dr. Abraham Morgentaler (PMH Boston, also affiliated with Harvard). He is among the few specialists worldwide who have been doing the current research on the intersect of T (or testosterone replacement/supplementation) therapy and PCa.

I'm not a doctor, so my words are an attempt to paraphrase what Dr. Morgentaler told me. The current research seems to indicate that as long as you do not have highly aggressive prostate cancer (like G8, 9 or 10), testosterone levels will have little to no impact on your cancer. As long as your testosterone level is above castrate level (usually considered to be 20-50 Ng/Ml), adding more or reducing the level will have no impact. As long as the prostate tissue (and prostate cancer tissue) have T levels above that 20-50 Ng/Ml level, they will do what they will do. Adding more T, or reducing T will have no impact unless you are going to reduce T to castrate level, and this drastic reduction of T is not indicated in the treatment of low-risk or favorable intermediate risk PCa.

Another thing that Dr. Morgentaler told me is that my prostate cannot tell the difference between T produced within my body and T purchased at the pharmacy. If my body cannot or will not produce a normal level of T, then by all means I should consider external T therapy.

If you are looking for research data, there is a lot out there on the web. The theory about PCa not being sensitive to relative level of T is called the "Saturation Theory." There is at least one, maybe more, paper describing the research and their findings. There are also a number of papers describing the measured impact of supplemental T on PCa patients, some authored or co-authored by Dr. Morgentaler, but some conducted by others.

The fact that your PSA rose when you started T therapy is not unusual. The extra T causes growth of normal prostate tissue, which will cause an increase in PSA. With that growth of normal tissue may also come a growth of any pre-existing PCa. T will NOT cause the cancer, but if cancer is present, it will grow along with healthy prostate tissue. When I started T replacement therapy about 5 years ago, my PSA rose from around 1.9 to about 3.2. There it remained steady for a few years, until about a year ago - and the rest is history (at least most of it).

BTW, Bob - If I had your Gleason 6 PCa, I would go for the T. You're even lower risk than my single G7 core makes me.