Testosterone Recovery Profiles after Cessation of Androgen Deprivation for Prostate Cancer

[madman]

John P. Mulhall, MD, discusses the significant sexual and non-sexual adverse events of low testosterone resulting from using androgen deprivation therapy (ADT) to treat men with prostate cancer. He emphasizes the need for physicians to counsel patients on long-term expectations and to obtain fully informed consent prior to the initiation of this therapy.

 

[madman]

 

[madman]

 

[madman]

 

[Nelson Vergel]

Wow. Most men did not have T checked before ADT and a third never normalized T production. Poor souls. I hope we get data on how many are put on TRT after a year of stable PSA, etc

 

[madman]

Wow. Most men did not have T checked before ADT and a third never normalized T production. Poor souls. I hope we get data on how many are put on TRT after a year of stable PSA, etc

A critical point in the lecture.....0:54-4:20

Not hypogonadism/testosterone deficiency.....AGONADISM (absent testosterone).....brings chills down my spine!

 

[Arturo]

I have been working with John Mulhall for almost one year now and am very pleased with the results using Testosterone Gel 1%. Feeling much more energetic with an adolescent's libido, returned fully from Lupron! I heartily recommend Dr Mulhall. He's a Mensch!

 

[D0UG]

That sounds like me. I have many of the common problems of low T but my doctors say they do not beleive the symptoms have anything to do with low T. To clarify, my T was 21 the last time it was checked and that was 9 months after a single shot of Lupron (ADT). I was on TRT for 5 years before ADT. My understanding is that the chances of my T production returning on its own is nearly zero. I'm contemplating on going outside for HRT but I hate like hell to have to pay thousands of dollars out of pocket to fix something caused by doctors who were paid under my insurance.

 

[Arturo]

I would consult with Dr. Mulhall. He is the expert in this field with numerous research papers on what sounds like your situation.

 

[D0UG]

Nov. 2020 I finished radiation treatment (RT) for prostate cancer (Gleason 6
Stage: Stg IIA T: T1c N: N0 M: M0). I had previously been been on testosterone replacement therapy (TRT) and over a period of 5 years my PSA increased to 11. I stopped TRT in Jun 2020 and PSA dropped to 2. After RT, the PSA was <0.1 or unmeasurable but I was miserable with my free testosterone level at 20. I recently resumed TRT and my first blood test shows PSA is at 2 again. I wonder if 2 is going to be my new baseline or does that indicate the cancer is active again.

 

[Ribeye]

Nov. 2020 I finished radiation treatment (RT) for prostate cancer (Gleason 6
Stage: Stg IIA T: T1c N: N0 M: M0). I had previously been been on testosterone replacement therapy (TRT) and over a period of 5 years my PSA increased to 11. I stopped TRT in Jun 2020 and PSA dropped to 2. After RT, the PSA was <0.1 or unmeasurable but I was miserable with my free testosterone level at 20. I recently resumed TRT and my first blood test shows PSA is at 2 again. I wonder if 2 is going to be my new baseline or does that indicate the cancer is active again.

I am NOT a physician, and am actually a fairly new member here. Learning tons from this site. It is my understanding, after treatment (radiation therapy) IF you also have some BPH, HRT can aggravate the BPH causing prostate enlargement to some degree. This could cause your PSA to increase somewhat. That is why it is important to be followed by a good urologist who will do regular digital rectal exams, (feeling for lumps or bumps that were not there previously, but also can tell if your prostate has enlarged more (which explains the PSA increase) IF your urologist does feel a lump or bump or anything unexplained by your treatments, he can order a biopsy, or perhaps and MRI to image the prostate and rule out for additional problems. The data is pretty clear, HRT does not cause prostate CA. One thing to keep in mind, radiation therapy takes time work. It is the impact of the total dose of radiation, over time, even after the initial treatment period that eventually kills the CA and also causes scaring to occur in the prostate of healthy tissue. It may not have completely killed the cancer if you re started HRT too soon.

 

[Nelson Vergel]

There is a good review here:

Testosterone Therapy After Prostate Cancer Treatment: A Review of Literature

ABSTRACT Introduction: Although testosterone therapy (TTh) is the standard practice in otherwise healthy hypogonadal men, this therapy has historically been contraindicated in men with a history of prostate cancer. Recent evidence suggests that there is minimal or no prostate cancer growth in...

www.excelmale.com

 

[Nelson Vergel]

Please watch this:

 

[D0UG]

I am NOT a physician, and am actually a fairly new member here. Learning tons from this site. It is my understanding, after treatment (radiation therapy) IF you also have some BPH, HRT can aggravate the BPH causing prostate enlargement to some degree. This could cause your PSA to increase somewhat. That is why it is important to be followed by a good urologist who will do regular digital rectal exams, (feeling for lumps or bumps that were not there previously, but also can tell if your prostate has enlarged more (which explains the PSA increase) IF your urologist does feel a lump or bump or anything unexplained by your treatments, he can order a biopsy, or perhaps and MRI to image the prostate and rule out for additional problems. The data is pretty clear, HRT does not cause prostate CA. One thing to keep in mind, radiation therapy takes time work. It is the impact of the total dose of radiation, over time, even after the initial treatment period that eventually kills the CA and also causes scaring to occur in the prostate of healthy tissue. It may not have completely killed the cancer if you re started HRT too soon.

I was told that after the radiation treatment (IGRT) my prostate would be mostly dead.

 

[Ribeye]

Please watch this:

Dr. Khera is remarkable physician. He covers so much ground so quickly it is hard to follow all of his points. Regarding those who have been treated for Prostate Ca, getting HRT, with low stable PSA for 5 years and low T (under 250) those patients with HRT could expect some PSA change generally increasing PSA (as the prostate is getting saturated) but not likely to get bPH worsening and may actually get improvement. However, if I understood his position, there is NO evidence to suggest the patients cancer could or would return, or if their risk is higher (unless they were a high risk patient to start) of their cancer returning? I am wondering at what point he would suggest to a patient that a PSA elevation should be followed up by more aggressive testing or examination than a DRE? A half point, full point, over 4?