PSM....is TRT safe?

First, remember that I am NOT a doctor. I am just a patient with some sort of related experience.

Also note that my comments are specifically made with your G3+4 diagnosis in mind. Had your Gleason score been any higher, I would not even feel qualified to comment, as my learning was based upon what I learned in choosing treatment for my own G3+4 PCa.

Next - What has your "native" T level? I would think that if your native T level is above castrate level, then the addition of supplemental T would have little to no significant impact on your disease control or even PSA. Yes, adding supplemental T probably will introduce some "noise" to your PSA readings. It could go up some, but should then stabilize. In this case, the increase would NOT mean that PCa has recurred. It would be related to the added T.

My thoughts are based upon Dr. Morgentaler's "Saturation Theory" in which he (and others) shows that as long as your T level is above castrate levels, the addition of more T will have no significant impact on PCa.

He further opines that unless there is a disease-control/medical reason to withhold T, there is no reason not to administer supplemental T to the symptomatic hypogonadal patient, even if he has PCa. When I met with him, we also discussed the fact that although some uro's refuse to supplement T, in the belief that somehow external T has some different impact on the body and your cancer. We joked, but our conclusion was that the body cannot tell the difference between the T it manufactures internally and that which I purchase at the pharmacy.

Sorry for the long winded response, but my layman's opinion is that if you are symptomatic for low T, and if your native T level is above the castrate level, then the addition of supplemental T will help, not harm. Personally, I'm betting that (the top docs and) I am right, as I have continued my supplemental T before diagnosis, through treatment, and still after treatment. So far, so good.

I tried to open the linked articles, but I get the dreaded "404 Page Not Found" error.

My consultation with Dr. Morgentaler brought me to read many of the articles he has published and abstracts of research studies he has worked on. If you google his name and add the phrase "saturation theory" I'm sure the references will pop up for your review.

For many years my T was in the 250-300 range, and I became gradually more symptomatic. Eventually it went down to the low 200's and things got really nasty, so my uro prescribed TRT. I was diagnosed about 5 years later with PCa. It was a real struggle to put together a team (uro/RO) to manage my case, accepting my choice to maintain TRT through treatment and after. I simply cannot imagine what my life would be like today had I simply taken the advice of the first RO I met with, and stopped TRT forever.

Glad I saw this. I have a consult call with Morgentaler tomorrow morning. I’ll report back.
Bob

island time said...


I can see....given my path....that this could be a hard sell.

Not sure why you say this. The only negative I can see is possibly your surgical margins, but your PSA history is low and stable, so why wouldn't you consider TRT? It might be worth a phone consult with Dr. Morgentaler to get his input.

I skipped the phone consult and went directly to booking an office consult with Dr. Morgentaler. I flew out from Chicago in the morning and back in the evening. That way I was "officially" a patient of his, and he could not only consult with me, but also could submit a written encounter summary to my local uro and RO. With his written recommendations, my local docs are happy to manage my care within his guidance. If we encounter any issues, I can go back to see Dr. Morgentaler again, or we can decide locally what path to take.