Testosterone Replacement Therapy after RALP

we both about the same, age included. I get firmagon once a month and take Abiraterone daily. Been on this for the last 18 months. Have the fatigue since the beginning. I will say I don't believe it has gotten worse over time but I sure know I have it. You just have to do the best you can to keep moving. Having it every day at times wears me down. I sometimes have to fight through it so I don't fall into that hole. I consider a good day when I keep my head on straight and have a good time, fatigue be damned. Welcome to the site, so many here that share, and I wish you the best on your journey. Best to all

The reason they give you prednisone with Zytiga is to replace the cortisol lost by taking Zytiga.

Low cortisol can be a problem. According to a web search low cortisol causes this.

‘Low cortisol levels can cause any of the following symptoms: Fatigue and morning sluggishness. Depression. Anxiety.”

It’s possible you can talk to your doctor into increasing your prednisone from 5mg to 7.5mg or 10mg to see if that relieves some of the fatigue problems. Some doctors actually give their patients 10 mg of prednisone with Zytiga. Can’t hurt to ask.

I've been on 10mg of prednisone since the beginning. I will talk with my oncologist next month about this. Does cortisol levels show up in blood work? I get tested for quite a few every month, I look at them but don't understand a lot of them. Of the list you mentioned the only one I could cross off is anxiety, otherwise the list fits me. Thanks for the info. Best to all

I've been on 10mg of prednisone since the beginning. I will talk with my oncologist next month about this. Does cortisol levels show up in blood work? I get tested for quite a few every month, I look at them but don't understand a lot of them. Of the list you mentioned the only one I could cross off is anxiety, otherwise the list fits me. Thanks for the info. Best to all

The reason I recommended more prednisone was because I thought your problem was fatigue. now that I review what you said I do not see that mentioned.

I’m not sure what changes you are referring to. I was speaking to someone yesterday who has major fatigue, problems, and hard time getting out of bed in the morning. he’s on 5 mg and a shortage of cortisol could be causing his problems, and more prednisone might fix it.

Not knowing the details of “changes in me” Makes it difficult to suggest anything. Maybe in your case you’re taking too much prednisone.

You definitely have to talk to your doctor and try to resolve this. You might consider getting a palliative care doctor. They work with people to resolve conflict with medicine they are taking that are causing them medical problems.

Hi,

I'm 49. Gleason 3+3.

Last December my PSA doubled from around 2 to 4.15, had a Multiparametric MRI, it showed a lesion and the fusion biopsy confirmed a localized tumor with seemingly nothing affected outside the prostate itself. Three positive cores out of 18. One within the lesion; two more in the same lobe outside the lesion. The other lobe is clean.

In these three months, two more blood tests showed the PSA went down to 2 again (January) and up to 3 again (February).
My T is high naturally, in the 900-1000 ng/dL range. I've always assumed it is because of my vigorous workouts and healthy habits.

My father had prostate cancer too, his prostate was removed and he has not had any recurrence to date. I don't know what Gleason he had. And I won't know till after surgery, because I've decided not to worry him and my mother until everything is taken care of.

Because, yes, after thinking it through and doing my research I've decided to undergo surgery and it is scheduled for next week.

My surgeon says he believes my nerves can be spared, and he is confident I will be dry in 3 months and optimistic about my erections.

However, I'm having second thoughts. I wonder if my naturally high T will increase my risk of recurrence even if everything is removed now. I also doubt that the outcome in terms of functionality will be as positive as my surgeon implies.

So, I'm not sure if it's stupid or overreacting to undergo surgery now.

I do know that if I don't undergo surgery, I will be thinking about it 24/7. And I'm afraid that if I don't do it now, even under AS, (a) my cancer will progress suddenly beyond treatment or (b) it will progress slowly but beyond a nerve-sparing stage or (c) other health issues will arise down the road, so when (if) I really need to undergo surgery, I won't be as prepared either physically or economically to face the procedure.

I don't know. I had made up my mind, but a week prior to surgery, I question my decision.

Hi,

I'm 49. Gleason 3+3.

Last December my PSA doubled from around 2 to 4.15, had a Multiparametric MRI, it showed a lesion and the fusion biopsy confirmed a localized tumor with seemingly nothing affected outside the prostate itself. Three positive cores out of 18. One within the lesion; two more in the same lobe outside the lesion. The other lobe is clean.

In these three months, two more blood tests showed the PSA went down to 2 again (January) and up to 3 again (February).
My T is high naturally, in the 900-1000 ng/dL range. I've always assumed it is because of my vigorous workouts and healthy habits.

My father had prostate cancer too, his prostate was removed and he has not had any recurrence to date. I don't know what Gleason he had. And I won't know till after surgery, because I've decided not to worry him and my mother until everything is taken care of.

Because, yes, after thinking it through and doing my research I've decided to undergo surgery and it is scheduled for next week.

My surgeon says he believes my nerves can be spared, and he is confident I will be dry in 3 months and optimistic about my erections.

However, I'm having second thoughts. I wonder if my naturally high T will increase my risk of recurrence even if everything is removed now. I also doubt that the outcome in terms of functionality will be as positive as my surgeon implies.

So, I'm not sure if it's stupid or overreacting to undergo surgery now.

I do know that if I don't undergo surgery, I will be thinking about it 24/7. And I'm afraid that if I don't do it now, even under AS, (a) my cancer will progress suddenly beyond treatment or (b) it will progress slowly but beyond a nerve-sparing stage or (c) other health issues will arise down the road, so when (if) I really need to undergo surgery, I won't be as prepared either physically or economically to face the procedure.

I don't know. I had made up my mind, but a week prior to surgery, I question my decision.

If you weren’t already scheduled for surgery, I wouldn’t tell you about the things below but it seems like you came here to get other people’s opinion.

With your father having prostate cancer it greatly increases your risk. My father died of it and my brother got it at 76. I got it at 62 because my mother added on, by giving me BRCA2.

If you review the recent medical information about a Gleason six you will find the medical community feels that people with a Gleason six are over treated. Staying on active surveillance is the optimal thing at this point, Unless they found some extenuating circumstances in your biopsy or heredity. You can look on YouTube for videos about it.

Here is a video with Dr. Laurence Klotz, one of the experts on active surveillance. He can give you answers as to why you would or would not be a good candidate for active surveillance.

Have you had hereditary genetic testing? Has it been offered to you by a doctor? You can get it done free with the below link. Do not check the box to get you want your doctor involved or they won’t send you the kit. It takes about three weeks to get the results and then a genetic counselor will call you.
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Prostatecancerpromise.org