RT, RP and TRT

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sheepguy
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Date Joined Nov 2010
Total Posts : 752
   Posted 10/5/2017 1:43 PM (GMT -7)   
A shearing client of mine was recently diagnosed with PC 2 pos cores of 12 1 grade group1, one grade group 2. He is currently on TRT. His uro told him that he can resume TRT one year after RP, but never after RT...without ADT, I think. Is this the current thinking? He asked the uro..a surgeon, why and he said "trust me". I guess Matt accepted that.

Michael_T
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Date Joined Sep 2012
Total Posts : 2538
   Posted 10/5/2017 3:55 PM (GMT -7)   
FWIW, I had radiation and I've had discussions with my doc about TRT. He's okay with the idea of using it, although he'd rather wait a bit longer. (And I'm pretty sure I'm not going to do it anyway. It's sort of peaceful having low T.)

But I suppose in this case the uro here is basing his thinking on whether or not he still has a prostate. Just not sure how knowledge a uro is on follow-up for radiation.

PS This is the first post I can recall that started out, "A shearing client of mine..." ;)
Age 56, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
3/17: T = 167, PSA = 0.13

JNF
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Date Joined Dec 2010
Total Posts : 3403
   Posted 10/5/2017 4:10 PM (GMT -7)   
New for me as well. Didn't realize sheep were susceptible to PCa.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011

Tall Allen
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Date Joined Jul 2012
Total Posts : 8943
   Posted 10/5/2017 6:47 PM (GMT -7)   
Depends on whom you ask. If you ask me or my RO or my PCP, TRT after RT is OK. "trust me" is only a suitable answer if you trust him already.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Fauntleroy
Regular Member


Date Joined Dec 2012
Total Posts : 334
   Posted 10/5/2017 8:40 PM (GMT -7)   
2013 Total T level 9, 2014, 400 up to 587, since then dropping every year, now 299. Asked my RO about TRT, and the answer was, "not recommended due to your history of prostate cancer"

This from a well known RO
56 yrs old @Dx, on 11/12 Staged T3A
PSA-2007-2.7, 2011-5, 2012-5.6 up to 5.9. 1st 12 core biopsy-8 of 12 cores positive, both lobes W/Tumors in Apex,PNI,extra capsular ext. Gleason 3/3 & 4/3, 2nd opinion Oppenheimer labs, to 3/4. Range 5-40% in core involvement.
Started short term HT 1/5/2013, Dart 1/31- 30 sessions. Brachy 5/08/13, Boost radiation 8/2
After treatment has remained steady @ .1

Michael_T
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Date Joined Sep 2012
Total Posts : 2538
   Posted 10/5/2017 9:44 PM (GMT -7)   
But...would he have told you TRT was okay if you had surgery? I think that's the interesting distinction here. The uro is saying it's okay after one year if you had surgery, but it's never okay if you've had radiation.
Age 56, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
3/17: T = 167, PSA = 0.13

Paxton
Veteran Member


Date Joined Aug 2016
Total Posts : 912
   Posted 10/6/2017 7:12 AM (GMT -7)   
Sorry - but once again, I'm an outlier. I have been on TRT for about 6 years now. . . before diagnosis, during SBRT, and continuing after. I consulted with Dr. Morgentaler (in Boston) about this, as he has spent much of his last 20 years or so researching the intersects between TRT, testosterone and PCa. His position is documented in many published works, but the one I hang my choices on is the Saturation Theory.

This theory shows that as long as your T level is above castrate level, increases or decreases in your serum testosterone level will have no significant effect on the development, growth or progression of PCa. Prostate cancer cells only need a small amount of T to "do their thing." So, as long as the patient's diagnosis does not require elimination of T, then why deprive him of this necessary hormone when there is no medical benefit to doing so? Also, and a very important point, is the fact that your prostate and your prostate cancer cannot tell the difference between T manufactured within your body and T purchased at the pharmacy. T is T.

So, long story made short, with Dr. Morgentaler's input and cooperation, my RO and local uro are managing my TRT all through this journey. Since I had radiation, I do have to accept the fact that there could be some noise in my PSA readings, but really, if the body cannot tell the difference between naturally produced and store bought T, what difference could there be? I guess there could be a measurement bias introduced if the patient's TRT was not a daily dose, as there could be spikes with periodic injections, but since I use a daily gel, the dose is consistent from one day to the next.

We each have to make our own choices, but if your client is in a low to favorable intermediate risk category, he should consider continuing his TRT. If his doctors will not consider this, he might be well advised to consult with other doctors before making his final choices. (Dr. Morgentaler is quite accessible, if one is willing to travel to Boston to see him.)

I really struggled with this when first diagnosed, as I was badly symptomatic (adult onset hypogonadism) prior to starting TRT, and just couldn't accept having to go back there unless there was a solid medical benefit to doing so.
Age 68 at Dx
PSA history: 2000-2012 0.9-1.2; 06/2012 started T replacement
2013-2015 3.0-3.3 (new normal); 11/2015 4.6; 05/2016 5.7
Biopsy: 12-core biopsy 07/2016; 3 cores G3+3, 5% or less; 1 core 3+4, 15%; 1 core HGPIN; 2% of gland involved. Summary G3+4.
CyberKnife SBRT with Dr. Hirsch; start 11/15/16, finish 11/23

sheepguy
Veteran Member


Date Joined Nov 2010
Total Posts : 752
   Posted 10/6/2017 7:24 AM (GMT -7)   
I'm not sure how symptomatic he is, but I think he,like you, is reluctant to back there either. On he other hand, he is exactly a nuanced type of guy..if you will. He's probably going to go for the "get it out" route , especially given the doctor's advice. He is not inclined to seek other opinions either even though there are good options withing 100 miles of his home. So, whatever, I told him what I know about it , he can take that for what it's worth.

Oh yeah,wise guys, we don't refer to the sheep as the clients..that would be too many to keep track of...and the billing would be problematic. smile

sheepguy
Veteran Member


Date Joined Nov 2010
Total Posts : 752
   Posted 10/6/2017 7:28 AM (GMT -7)   
NOT a nuanced guy ,that is

Paxton
Veteran Member


Date Joined Aug 2016
Total Posts : 912
   Posted 10/6/2017 11:28 AM (GMT -7)   
sheepguy said...
NOT a nuanced guy ,that is


That's too bad. He probably has choices that he will never learn about.

His loss.

P.S. If you think the sheep would present a billing problem, consider the collection problem. . .
Age 68 at Dx
PSA history: 2000-2012 0.9-1.2; 06/2012 started T replacement
2013-2015 3.0-3.3 (new normal); 11/2015 4.6; 05/2016 5.7
Biopsy: 12-core biopsy 07/2016; 3 cores G3+3, 5% or less; 1 core 3+4, 15%; 1 core HGPIN; 2% of gland involved. Summary G3+4.
CyberKnife SBRT with Dr. Hirsch; start 11/15/16, finish 11/23
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