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T level while on ADT

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Posted 9/4/2014 11:45 AM (GMT 0)
I've got a question regarding T levels when on ADT - what's the target?  I've read the old standard was <50 but the newer standard is <20 which also tends to favor a more durable ADT before becoming resistant.  But I can't find a cut and dry industry standard on what it should be. 

I am currently on quarterly Lupron shots with Casodex daily - 50mg.  My last T level was <33 and DHT <5.  How would I get to a lower T level, should I give the current ADT more time or add something else?  Higher dose of Casodex?  Add Avodart? 

I was diagnosed in March with a Gleason 9, Stage 4, I started on ADT immediately upon DX so it's been about 5 months, recent bone scan showed a good response to current ADT and I am currently undergoing IMRT of the primary tumor and pelvic nodes.

Ed

Posted 9/4/2014 1:30 PM (GMT 0)
My docs said the lower the better and were looking for less than 30 T.   Mine got down to 3.   I was on six month shots of Lupron or Eligard with a daily Avodart in the form of Jalyn.   I have been off the shots for a year, but remain on Jalyn.   I will have my next quarterly PSA next month and will also pull the T level.

As I understand the Avodart does not affect the T level, but rather the DHT.   So adding the Avodart, while helpful with the cancer control, will not lower the T.   Same with Casodex.   It does not lower the T level, rather it sets up a block between the T and the receptor on the PCa cell so the cell can not feed on the T.   It is helpful with cancer control, but doesn't lower the T.

Posted 9/4/2014 2:23 PM (GMT 0)
Good question Ed
I've been wondering the same. My Urologist would like to see the T at zero, but last reading was at 16. I think it's been as low as 7.

I just went off of Xtandi due to nasty body aches/bone pain & other S/E's, but will continue Lupron and start up on Casodex again.

BTW, I've been following your posts but haven't chimed in yet - good luck. This is a marathon, not a sprint.....

Best
Posted 9/5/2014 3:21 AM (GMT 0)
What you said is exactly right -- you ideally want your T level below 20, but anything below 50 is considered castrate. But when you write "<33" that means the lab you use isn't measuring anything below 33. Your actual T level may very well be lower than that right now, but you can't tell from that lab test. Perhaps you can find a lab that reports lower T results.

Let me throw at you one more thing to give to your RO for discussion:

Adjuvant radiation, androgen deprivation, and docetaxel for high-risk prostate cancer post-prostatectomy: Results of RTOG 0621

Multimodal treatment for high-risk prostate cancer with high-dose intensity-modulated radiation therapy preceded or not by radical prostatectomy, concurrent intensified-dose docetaxel and long-term androgen deprivation therapy: results of a prospective phase II trial

- Allen
Posted 9/5/2014 12:16 PM (GMT 0)
Thanks Allen,

Thanks for your comments.  When I read your post I was wondering why my uro didn't tell me that when I questioned him about it so I went back to look at the lab report again and my bad... it simply reads 33 not <33.  I am planning on getting my T level checked again next week, I see my uro at the end of the month for my 3rd Lupron shot, if it is not lower I will discuss with him how to get it lower - any ideas?  Or do I suggest a triple blockade by adding Avodart to the Lupron and Casodex so that any T that is floating around doesn't stand a chance of getting converted to DHT?

Interesting article, back when I was considering Taxotere my medonc said that if I was going to go that route that I would need to do it before IMRT, I guess he was concerned about the effects on my immune system.  But I've decided to pass on the chemo for now, don't want the side effects, I'd like to keep working and enjoying a good QOL.

Recent bone scan results (got em this week) showed no progression of bone mets and less uptake from existing mets "consistent with a favorable response to treatment" leading my radonc to say that this lends even more credence to treating the prostate and pelvic nodes like we're currently doing.  I feel pretty good about current treatment plan of ADT, IMRT, diet, excercise, supplements, metformin and increased my statiin dose to keep LDL as low as possible together with faith and a strong support group.

Ed

Posted 9/5/2014 3:25 PM (GMT 0)
T=33 ain't bad, and PSA=.2 ain't bad. You can maybe push your PSA down a fraction if you get it lower and/or take Casodex and Avodart. Some guys get lower T from Firmagon than from Lupron. But with multiple mets, some small fraction of the cancer cells are probably already hormone resistant, and it may be impossible to get to completely undetectable PSA without some bigger guns.
Posted 9/5/2014 3:29 PM (GMT 0)
The lower your "T" the better ADT works...In some men "chemical castration" is not wholly effective...The "T" level stays higher than what is desired. In these cases, surgical castration can be used which produces the lowest possible "T" level and the most dramatic response to the ADT...This is rarely done in the States but is fairly common in other countries..
Posted 9/5/2014 3:39 PM (GMT 0)
Recieved my most recent PSA results this morning, had blood drawn on Monday prior to the start of IMRT and I'm happy to report that it is now at 0.1, still making progress!  Went from 88 to 0.1 in 5 months on Lupron and Casodex.
Posted 9/6/2014 4:30 AM (GMT 0)
Good news on the PSA Ed. I assume they did nto measure T this time.

ere is my PSA and T before and after I started Lupron on 3-28-13. After 1 month it was 24 which is nto that different than your 33

Date PSA Testosterone
20120201 1.7 646
20120822 2.62 325
20130115 3.68 293

started Lupron 3-28-13

20130426 0.90 24
20130808 0.68
20131112 0.20 5
20140211 0.12 <3
20140513 0.10 3
20140609 0.23

On Zytiga for only 4 days to get PSA drop to 0.07 then suspended takingZytiga til after I had qualified for Provenge with 2 PSA increases at least 14 days apart

20140628 0.07 <20
20140710 <0.04
20140731 0.03 <3
20140812 0.04 8
20140826 0.05 11

resumed Zytiga as soon as I got the PSA result later that day, so morning of Aug 27 resumed Zytiga but instead of 5 Mg Prednisone twice a day, 50 Mg Inspra (eplerenone) once a day

20140904 0.02 <6

When I had the gold fiducials placed yesterday, they did a TRUS and prostate size is now 15 versus 50.4 pre-Lupron a year and a half ago.

My Provenge weekends are 9/12-9/15, skip 2 weeks instead of 1 to attend GFMPH, 10/3 - 10/6 and 10/17-10/20.

My SBRT dates overlap 10/6 - 10/8, 10/10, 10/13 and 10/15.

So when my T-level was 24, my PSA was 0.90 and when my PSA was 0.1 my T-level was 3, but everybody's PSA and T and PCa are different.

LupronJim
Posted 9/6/2014 12:06 PM (GMT 0)
Hey Jim,

I plan on getting blood drawn this week and a new T test done so I have info when I see my uro for 3rd Lupron shot, if not <20 than I will push a little harder for him to modify meds in order to get it there, he's a pretty good guy and is willing to take suggestions - no ego issues which is a good thing.

Good luck with your SBRT and Provenge.  I'm curious why you were trying to get on Provenge when it seems like things were goiing fairly well - just being agressive I'm assuming? 

I finished the first week of IMRT - no issues yet and I don't expect any for a couple of weeks after another 20 rounds or so.  I did have to give up my supplement regimen however while recieving IMRT.  Just about everything I was taking - Wheat grass, Selenium, Soy, Vitamen D, Krill or Fish Oil, Zyflamend, all have strong antioxidant qualities and my radonc explained that radiation kills the cancer through an oxidation process so taking antioxidants could make the radiation less effective or at least be counter productive.  I hate giving them up since I think they were helping me to feel pretty good.  I can restart once IMRT is completed.  Not sure if its the same with SBRT perhaps a discussion to have with your radonc if you havent't already.

Overall a good week, good news on the bone scan and good news on the PSA while being proactive with the IMRT and taking on the primary tumor - the battle goes on!

Ed

Posted 9/6/2014 2:34 PM (GMT 0)
Hi Ed.. Do you have a Medical Oncologist on your treatment team? Sometimes Urologists stay in the game a little too long..If you have bone mets, then your treatment leader should be a Medical Oncologist...Are you taking calcium? Important to do that when on ADT..I would scratch the selenium off your supplement list and add Posi-T, which has demonstrated its effectiveness in a clinical trial..
Posted 9/6/2014 4:27 PM (GMT 0)
Hey Fairwind,

I technically have a medonc but I am looking for another, one who specializes on PCa, my current medonc seemed willing to let my uro be in the lead, same for my radonc, not sure if that's due to some understanding that the docs have with other or what, they seem afraid to step on toes.  Meanwhile the uro is a good guy, easy to work and things seem to be going in the right direction with what is is prescribing so I'm not in a big rush but I know there will come a time when a medonc is needed.

The selenium is out of Snuffy's book, I had some hesitation at first until I read his book and started taking it - it's on his list fo daily supplements.  Not currently on calcium but I know how important bone health is on ADT, I'm having a bone density test done on Monday to see where we're at.  It was one of the tests that I had to ask for, just like T and DHT, I was surprised no one tested those until I requested it after joining the club and doing some studying. I've learned that you really need to be your own advocate.  Previous bloodwork showed Calcium levels in good shape at the high end of the normal range. 

What is Posi-T?

Thanks for responding to my post.

Ed

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