G7 recent uro visit and considering testosterone replacement therapy

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Regular Member

Date Joined Mar 2012
Total Posts : 239
   Posted 11/16/2013 9:19 PM (GMT -6)   
Had my quarterly visit with surgeon/uro recently. We went over the 2nd opinion pathology from Epstein. Same as original path except more info on the one +margin -- it was lateral, 3mm, Gleason 3+3=6, and intraprostatic. Uro seemed pleased with that. I asked if there could be any cancer still in place from the intraprostatic incision. Said he didn't think so. I guess the G7 cells I had are safely back in the original pathologist's freezer now. Hope so anyway. Had another doc (relative) tell me tiny flecks of Pca can break loose and float around, too, even before surgery. Didn't pursue that with her. Maybe she was referencing the perineural invasion?

Along with the PSA test I had before visiting him, also had first T test in my life -- 223. i think that explains my sleeping difficulties (getting worse), zero libido, skin irritations not healing as fast, dumbbells not building much muscle, generally achy and bla. A little mental fog, though I'm hanging in there. Also cry on rare occasion -- like when my team loses (but who wouldn't - ha ha)

I broached TRT with uro (formerly City of Hope guy). To my surprise, he is of "saturation theory" school regarding TRT, but told me "if you polled 200 uros on this, I would be one of the more aggressive ones on this". Said he is already treating some men in this boat. Also told me he would be ok with starting me on it now, but if I wanted to wait another visit or two (they are every 3 months now), that would be fine, too. Six more months would put me two years out from the surgery. All PSAs have been undetectable (half of the tests of the ultra sensitive type).

Have a while yet before I would start, but have been reading everything I can get my hands on plus the prior posts here. Can sense I will really struggle with this, whereas getting from diagnosis through surgery was not really that bad, other than the associated administrivia. But this decision starting to feel a lot like I imagine Russian Roulette with one bullet in my .357 might be like (it's a five shot). I do feel pretty crappy a lot of the time, but am not keen on putting myself in a worse spot, either. Gives new meaning to phrase "pulling the trigger". I am sure being beaten down (lots of job and other stress), with low T, cloudy thinking, etc., makes it more difficult.

I know nobody can decide on TRT for me, but any input would be welcome.

64 now
Jan '08-'11 PSAs 2.2 2.5 2.7 2.6, DREs-
Jan '12: PSA 3.6, DRE+
Jan '12: MRI inconclusive
Feb '12: PCaDx pT2a, 4/12+ (3 @ 3+3, 1 @ 4+3); 3% tot cores; bone scan-
Apr '12: RALP; 3+4=7; pT2c pN0 pMx; 30%; 3mm r lat margin of 3+3=6 so pT2+; EPE-; PNI+; 8 LN-; SV-
PSAs: (all undetect); most recent 09/06/13: < .015

Post Edited (Bobbiesan) : 11/16/2013 7:33:28 PM (GMT-7)

Tall Allen
Elite Member

Date Joined Jul 2012
Total Posts : 10276
   Posted 11/16/2013 10:18 PM (GMT -6)   
For some reason, T levels get depressed post surgery and post RT. It took my T levels about two years to fully recover on their own. Mine was 224 after RT, but later climbed to over 600. I know how yucky the low T feels, but if TRT is scary to you, you might want to wait and see if it returns on its own. My preference was to wait because artificial TRT inhibits one's natural production of T. Another option is to see if you can jumpstart your natural production of T with human chorionic gonadotropin (hCG).
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 6 year results
treated 10/2010 at age 57 at UCLA
•PSA since treatment:
1/11:3.9 5/11:3.0 8/11:3.7 5/12:1.2 9/12:1.3 5/13:0.4
• SEs of treatment:
after 2 wks: mild urinary & rectal - last 1 wk
1 yr after: mild urinary - last 2 months
no ED

Veteran Member

Date Joined Jun 2013
Total Posts : 1852
   Posted 11/17/2013 8:54 AM (GMT -6)   
I was on androgel for ten years before RP due to hypogonadism. My T level was around 750 using androgel up from mid 200s. I stopped when I had bx which showed GL 9 PC. After RP this past Sept I'm still off androgel and don't feel that bad. Depending on what happens to my PSA over time I'll think about returning to androgel with advice of euro. Low T is not my highest priority at this stage in life.

Veteran Member

Date Joined Aug 2009
Total Posts : 665
   Posted 11/17/2013 7:37 PM (GMT -6)   
I'll not be presumptuous to give you advice, but just my experience.
My primary care physician told me after diagnosis with PCa, he would never prescribe TRT under any circumstances. My surgeon is more in your doc's camp. She was OK with supplementing my low T (in the range of 100 to 200 without supplementation) a year of <0.1 PSA after surgery, and was OK with the same >1 year of <0.1 PSA after SRT as well. I am grateful, I feel a lot better. For me, the quality of life is worth the possible risk. If I go above 0.1, I would plan to go off TRT. In the meantime I am glad for the opportunity.
Gleason,3+4;PSA 9.8,Nerve-sparing RRP,03/2008(Age 48 then),pT2c, 60g, neg margins; perineural & lymphatic invasion;3 lymph nodes removed,clear; seminal vesicles clear;Gleason 4 was 5-10%; PSA <0.1 until Oct 09:0.1; scans clear;monthly results from Jan 2010:0.2,.2,.17,.17,.24,.31,.29,.41, IGRT SRT started 8/4/2010, PSA@5 weeks in: .17,after:.12,.10,.06, .05 since

Regular Member

Date Joined Nov 2013
Total Posts : 67
   Posted 11/17/2013 8:59 PM (GMT -6)   
This is another area that appears to be all over the map with differing opinions and studies. My uro said he would be willing to look at TRT if and after treatment but not before (e.g., if I did AS). Right now I am off and managing through diet and exercise... though I do have some tough times and moments.

Not sure it helps, but here are some of the links I have regarding this subject:
link link link link link link link link link link link link
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