My regular urologist, who is not the doc I see for TRT (but is generally supportive of TRT), wanted me to stop testosterone completely prior to surgery and then evaluate six months after surgery (to make sure PSA was near zero). I think that was a pretty reasonable approach.
However, I next went to Memorial Sloan-Kettering Cancer Center in NYC and saw a prostate specialist / surgeon who also follows over 2,000 patients on Active Surveillance. He told me there was no need to stop the testosterone - as long as I was at reasonable levels (ie, not crazy high). As long as nothing unexpected is found during surgery, I can continue with the TRT post surgery. Working with the male sexual health practice at MSKCC, I think they genuinely weigh any potential cancer recurrence (which is very low) against all of the other health risks of having Low T. It’s a calculated risk, and one I’m comfortably willing to take - especially when I know I’ll be closely monitored going forward.
The good thing about surgery (assuming the cancer is contained within the prostate) is that the PSA test becomes an excellent cancer indicator - without a prostate, you should pretty much be at zero. If your PSA begins to rise again, you know you’ve got a problem. With that kind of reliable indicator, it makes a decision to resume TRT much less risky. Going the radiation route (as opposed to surgery) doesn’t offer the same comfort in monitoring.
