Testosterone Therapy and Prostate Cancer

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Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 8/4/2010 9:24 AM (GMT -6)   
I have been mulling over my lack of energy and other things for quite a while and giving full credence for it to the effects of my IMRT and MET radiation. In doing some reading I came across articles describing the effects of low testosterone. I even took a few online test to see if my symptoms met the match of low T.

It was during this research that I came across one of the most interesting articles that I have ever read. One that until recently has been flying in the face of accepted beliefs in the relationship of testosterone levels and PCa.

I thought this was a subject that could be well addressed and discussed here given the extent of the research and experience that exist with you guys. It is sure to raise questions and some lively debate.

Also, I have an appointment with my PCP today. She is with my team at MD Anderson and deals exclusively with the general health of cancer patients. I plan to open discussions with her and also request a T level blood test.

Here are just two of the articles I found. The first is the article that created the interest in me to do further research on the subject and the Dr. behind it. The second is the most recent I found, dated June 2010.

It appears the link I put here first takes you to a page that says the article is no longer available. So I am modifying the instructions on how to find it.

Enter "Destroying the Myth about Testosterone Replacement and Prostate Cancer", in your search engine, I use Dogpile. One of the references will come up with a link to the article at lef.org. This link should take you directly to the article. This one is the in depth article on the studies I was referring to. I know it is a hassle to get it this way, but it well worth the trouble.

www.aolhealth.com/2010/06/04/testosterone-therapy-and-prostate-cancer

I look forward to your comments and discussion. I value the education and experience of you all.

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.
5/7/10 PSA test 1.3 Sodium Fluoride PET Scan & CT SCAN -performed
5/20/10 PSA test 1.2 Holding off on future tests for 3 months- single lytic lesion found and scheduling radiation.
7/22/10 PSA test 1.3 - Begin radiation for MET on leg

Post Edited (Sonny3) : 8/4/2010 10:24:42 AM (GMT-6)


aspen4
Regular Member


Date Joined Dec 2008
Total Posts : 59
   Posted 8/4/2010 9:36 AM (GMT -6)   
Sonny
When I go on Intermittent Hormone Therapy I will have my PSA checked along with my T-Levels every 2 months. My doctors believe that the two need to be monitored. When the PSA goes over 1.0 I will go back on the Lupron train......and so on and so forth ;))

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 8/4/2010 9:47 AM (GMT -6)   
Aspen,

I fully understand the effects of HT and PCa. What these findings are saying to me is that it may be possible for me to be treated for low T and enjoy a higher level of Quality of Life, without pouring gas on a smoldering fire.

It is the relationship of T levels and the propensity for PCa that comes into discussion here foremost. Secondarily, it is the possibility of experiencing QoL and being able to live with PCa without making it worse.

Thank you for your input,

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.
5/7/10 PSA test 1.3 Sodium Fluoride PET Scan & CT SCAN -performed
5/20/10 PSA test 1.2 Holding off on future tests for 3 months- single lytic lesion found and scheduling radiation.
7/22/10 PSA test 1.3 - Begin radiation for MET on leg

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 8/4/2010 9:53 AM (GMT -6)   
Do we have the twilight zone effect in PCa? (LOL) I have heard this years ago and sources like Dr. Leibowitz and some others have patients whom have done such, I say they were selective patients and maybe assuming possible risk, but results have been shown...as anti-consistent as that sounds for shutting down 'T' that can fuel PCa. Our local Michigan PCa group (seminar gig with great onco-doc), had a doctor speaker come to our group about this idea, like 3-4 yrs. ago and explained some on it. Some patients were using a 'T' cream supplement idea and says it was not necessarily insane but was not for everyone to try either. It did help men gain strenght, virility and other goodies that T can do. I knew with my stats and history I was not even thinking about trying such.

So, whom would want to be the first to try this in our forum group? If one was fortunate enough to use this and not see large jump in PSA, maybe a great concept, but monitor psa closely..nobody wants PSA's in the hundreds or thousands level which do have issues to confront. You would need a good onco-doc to do this with proper monitoring and advice. As I have said many times...PCa is the jungle, twilight zone and limbo land...makes fiction look more believable at times. Anybody know of anyone doing this and if so, their history and stats??? It would be interesting to talk to those whom have done this and find out things.
 
(lef.org  is Dr. Strums website and link did not show the article for some reason-fyi)
Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 8/4/2010 10:02:50 AM (GMT-6)


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 8/4/2010 10:11 AM (GMT -6)   
Zufus,

I was hoping to hear from you on this. You are one of the guys here on HW who have an extreme grasp on things PCa related and express you thoughts and ideas with clarity. The fact that you did not immediately dismiss this possibility gives it some credence.

I called the author's office and had a really good discussion with one of his staff. I was invited to write a letter to the Dr. and detail my travels on the PCa path. I also questioned if the doctor was at present treating any individuals for low T who had been previously treated for PCa. He told me that after receiving my letter and questions I would most likely receive a call from the doctor himself to discuss it in further detail.

Don't get me wrong, I do not want to put myself in harm's way, but if I can improve my QoL without putting myself at greater risk of exploding PCa complications, I might seriously consider exploring low T treatment further. That is of course provided that the blood work shows that I do indeed have low T levels.

I am just trying to get a handle on things that I have been experiencing for a few years and have manifested themselves lately.

Thank you for taking the time to weigh in,

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.
5/7/10 PSA test 1.3 Sodium Fluoride PET Scan & CT SCAN -performed
5/20/10 PSA test 1.2 Holding off on future tests for 3 months- single lytic lesion found and scheduling radiation.
7/22/10 PSA test 1.3 - Begin radiation for MET on leg

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 8/4/2010 10:30 AM (GMT -6)   
I have modified my original post with the instructions on finding the referenced article. I apologize for not trying the posted link before I submitted it for discussion. I thought when I copied the link directly from my browser it would work as it did for me.

Sorry for the inconvenience. But please take the time to read the primary article. It lays the groundwork for this discussion. I think it is an important discussion and not just for me.

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.
5/7/10 PSA test 1.3 Sodium Fluoride PET Scan & CT SCAN -performed
5/20/10 PSA test 1.2 Holding off on future tests for 3 months- single lytic lesion found and scheduling radiation.
7/22/10 PSA test 1.3 - Begin radiation for MET on leg

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 8/4/2010 10:49 AM (GMT -6)   
Thanks Sonny between your journey and your wifes, it is amazing you have composure about all these issues and processes, it would be easy to drop some superlative words. I think if one is the proper canidate for using "t" cream or injections, a low level to start off may not be all that problematic for some, then maybe could be increased if psa is not much effected. But that is my s.w.a.g. (guess) on the limited info I remember from that PCa seminar on this.
I am sure we will be all ears to hear more on this.
 
 (LINK is inop so Google:  Dr. Leibowitz testostorone replacement or such)
Find that link at Google and others and read more one this.
Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 8/4/2010 11:05:44 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/4/2010 11:30 AM (GMT -6)   
Sonny,

I will stay out of the t-level/testestrome part of this conversation. Way over my head, and no nothing about it. Just don't underestimate how damaging radiation can be. Between both of your treatments, you have hit or gone over 100 gys. And what a lot of people don't relaize, that you can get the big post radiation physical crash months and months after the treatments are over. I have been through this twice, as you know, in just the past 10 years, and I am speaking first hand. The crash I had in 2000, was unexpected by me, and when it hit, didn't know what I was going through. That's when I had to go into cancer rehab, for six months, and then it was extended six more months. I was also 10 years younger and working a busy career at the time. This time, it hit me early, and here, some 8 months after treatments have ended, still have that daily wall of fatigue to fight, along with the pains associated with the collateral damage from the radiation. Both things, people are told, rarely happen. In my case, not very convincing.

I think you should follow through with what you are suggesting, no problems on my end, and let us know how it goes or at least what you find out along the way. Just glad you are thinking outside the "normal" box, and thinking ahead in your journey.

And like you, glad Bro. Zufus has his unique angle on things PC.


David
Age: 58, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 8/4/2010 4:55 PM (GMT -6)   
Zufus, you are right on about taking this very gently from the beginning. Not only in any dosages if T level proves to be low, but in beginning this in the first place. There are a lot of questions out there and definitive answers may be hard to come by.

David, your input is always valuable. You have more knowledge on radiation and side effects than any 10 of us combined on this board. And that is something I am saddened to say. Man you need to catch a break!

BTW to all. I discussed this with both my PCP and my Rad Onco today. The PCP ordered up the blood work and I stopped by to see the vampires in training on my way out.

I asked the Rad Onco if he knew of Dr. Morgantaler and his work, he admitted not. I discussed the nature of his work with him and he became very interested. He said he would review the articles and studies and we would talk about it further next week when I see him at the finish of my radiation. I will know the T levels tomorrow afternoon.

If the T levels come back as normal I am back to square one in trying to figure out some of the things I am and have been experiencing. I.E. loss of muscle mass, low stamina, loss of weight, mood swings, sleep issues and so on.

Of course I could write it all off to dealing with cancer in our family for 5 years now. But that would be taking the easy way. I really want to know where all of this is coming from. I want a definitive answer if it is possible.

Thanks for the input,

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.
5/7/10 PSA test 1.3 Sodium Fluoride PET Scan & CT SCAN -performed
5/20/10 PSA test 1.2 Holding off on future tests for 3 months- single lytic lesion found and scheduling radiation.
7/22/10 PSA test 1.3 - Begin radiation for MET on leg

mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 375
   Posted 8/4/2010 6:07 PM (GMT -6)   
I have already posted on this issue before since it does involve me directly. My T level is 230, certainly on the very low end of normal if that. I think normal for my age of 54 should be around 500. My energy levels have been declining for years, along with decreased libido, and increased depression. When I told my wife that I could only inject trimix 2x/wk after my surgery for fear of Peyronie's she stated that that would be an improvement over what we had been doing before. I thought about and she was right, I didn't realize how little sex my wife and I were having, although obviously that could be for a multitude of reasons, not necessarily low T.
    I don't like the way I feel and the operating surgeon said he would order the T if I wanted it. The local internist was more concerned about possible recurrence of pca. So I guess we'll all have to read the articles and make up our own minds  I don't think there is going to be clear cut answer on this one for awhile, as it seems with all the issues surrounding pca.
my age=52 when all this happened,
DRE=negative
PSA went from 1.9 to 2.85 in one year, urologist ordered biopsy,
First biopsy on 03/08, "suspicious for cancer but not diagnostic"
Second biopsy on 08/14/08, 2/12 cores positive on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 6 both cores,
Clinical Stage T1C
Bilateral nerve sparing Robotic Surgery on 09/11/08, pathological stage T2A at surgery
No signs of spread, organ contained,
5 0's in a row now, 18 months out
Incontinence gone in early December '08,
ED still a problem, normal erections with manual effort but wife is now ill, not interested in sex anymore

Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 372
   Posted 8/4/2010 6:18 PM (GMT -6)   
Hey Sonny....I've been swimming in these waters for a while now, too. All the symptoms you post and a few others. My surgeon and local uro wouldn't even talk about T replacement until I was a year out from surgery because of conventional thinking, and just for the fact that it was a moot point to go there until a string of undetectable PSA's were registered. So now at 18 months, I still feel like crap. However, through persistence, I've been diagnosed with low ferritin (iron), low-average B-12, low Vitamin D-3, low-average zinc, and low-average testosterone (330's)...........the game plan we all agreed on was to get all the nutrients humming again, and see how I felt on all levels. Then, at 2 years, provided the undetectable PSA continued, we'd have the come-to-Jesus discussion about T supplementation. There are so many things it could be-----slow recovery from surgery, thyroid levels, depression, testosterone...and all can be interelated. I would suggest getting some of the above markers established for a baseline, and then make a plan. I'd be interested to see if any of your doctors brings these things up. Most of mine, including 2 endocrinlogists and a gastroenterologist, did not. Fortunately, my GP and another health professional were outside-the-box thinkers.................keep us posted on this, and I'll so the same.
 
Arnie in DE
Age 56 (biopsy & surgery)
PSA at Diagnosis-3.9
Biposy 8/19/08--4 of 12 cores positive; 5% involvement, Gleason 6 (3+3)
 
Surgery 1/26/09-DaVinci Robotic Prostatectomy at Presbyterian Medical Center/HUP-Phila, PA
Dr. David Lee
 
Pathology Report- Adenocarcinoma, no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, Gleason 7 (3+4), Stage T2C, NO MX, Prostate 61.8 grams, gland involvement 2-10%
 
Catheter removed after 8 days, totally dry at 3 months. ED issues continue, Viagra (via ADC) nightly (100mgs), VED use in earnest at 6 months. "Ball Park Frank" plumping at this point......ED at 10 months continues to improve, albeit slowly. Continued daily use of 100mg Viagra (ADC). Discontinued pump use; manual stimulation to varying states of erections; achieved penetratable erection on a couple of occasions----At 13 months, nocturnal erections are frequent. Still taking 100mg of ADC Viagra nightly. Libido still in the dumper, but working on it with doctors.
3 month PSA--<0.1
6 month PSA--<0.1
10 month PSA--<0.1
13 monthPSA--<0.1
18 month PSA--<0.1

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 8/4/2010 8:02 PM (GMT -6)   
M98 and Arnie, thank you for sharing your stories with me. This seems to be an area of dealing with PCa that doesn't come up and we don't talk about much.

Arnie, I appreciate you insight and history of the path of studies you have gone through. You have saved me valuable research time in looking for other contributing indicators. Having my PCP be a part of the MD Anderson team gives me comfort. Each of the other experts has their realm, and it seems to be dealing with the PCa in their area of expertise. My PCP is really good at looking at me as a whole patient and caring for me as such. When I explained to her why I wanted the T level blood work she added a few other things as well. I am thinking that she added some of the areas that you mentioned. If not I will inquire with her as to what else we need to look at.

I have an extreme need to feel as healthy as I can and have a much higher level of QoL.

There is only so much I can do at this point in dealing with the PCa. But there is a wealth of things I can do right now to raise my QoL.

Thanks guys,

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.
5/7/10 PSA test 1.3 Sodium Fluoride PET Scan & CT SCAN -performed
5/20/10 PSA test 1.2 Holding off on future tests for 3 months- single lytic lesion found and scheduling radiation.
7/22/10 PSA test 1.3 - Begin radiation for MET on leg

biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 8/4/2010 8:31 PM (GMT -6)   
I was on testosterone replacement therapy for 15 or so years before I got prostate cancer. My uno/surgeon was dead set against TRT after surgery saying that it is like pouring gasoline on a fire.

So I stopped the testosterone injections and inside of four months I was a basket case. No energy, no libido and deep depression to the point that I locked up all my guns to avoid suicide. I couldn't work, I couldn't carry on a conversation and about all I could do was to stare at the wall between crying spells.

After a raucous meeting with my uro/surgeon in which he maintained his no T position, I found another urologist that was willing to let me resume the shots. He said that the dicision to resume was mine to make being aware of the risk I was taking. He also considered my Pca stats which are listed below.

I resumed TRT taking 2 ml of testosterone cyponate every two weeks. Withing a week of the first shot I was feeling a lot better and have done well every since including wining a battle with lung cancer.

TRT after Pca (lots of acronyms) is not for everyone. I had to weigh quality of life vs risk of recuring cancer. At my age, QOL wins every time.

Jim
Age 76. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06. Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
50 mg Viagra + .05 cc Trimix = Excellent Results
PSAs from 1/3/07 - 8/02/2010 zero.
Next PSA - July/2011
Lung cancer dxed on 5/16/08. Surgery on 6/25/08 T1N1M0 - Stage IIA Finished 4 cycles of chemo on 11/7/08.
CT scans on 12/2/08 - 12/22/09 - in remission!!!
Next scan in August 2010.
Biker90's Journey
http://www.caringbridge.org/visit/jimrobinson
"Patience is essential, attitude is everything."

Piy
Regular Member


Date Joined Mar 2010
Total Posts : 145
   Posted 8/4/2010 8:36 PM (GMT -6)   
I am in no way claiming to know enough to support this or even have an opinion one way or the other.  But in case anyone is interested and hasn't already seen it, here is a link to a paper on high-dose testosterone co-authored by Leibowitz ... for your reading pleasure.  (hope it's okay to post this link as it is intended for informational purposes only).
 

davinci RRP October 2007
75% of prostate involved
Gleason 9
Positive margin
Scans clear
No detectable mets
SRT - February 2008
PSA:

At Dx: 8
Mar '09: 0.4
Jun '09: 0.7
Aug '09: 1.7
Feb '10: .008
Apr '10: .007
July '10: .006

Commenced Dr. Robt Leibowitz "Three Pronged Approach" protocol in August 2009

Completed chemo Dec 28 2009
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