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The paradox of testosterone and ADT

Prostate Cancer | Last Active: Apr 10 10:22am | Replies (82)
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@northoftheborder

I think all prostate cancer is usually hormone-sensitive ab initio. What happens is that once you suppress the hormone-sensitive cells, the very rare mutated cells that don't depend on testosterone eventually become dominant. Various treatments can slow that process down for people with metastatic PCa, perhaps to the point that it doesn't happen before you die naturally of old age. ARSI like the -lutamides are especially effective at delaying castrate-resistance when combined with ADT.

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Replies to "I think all prostate cancer is usually hormone-sensitive ab initio. What happens is that once you..."
dpfbanks | @dpfbanks | Apr 7 9:43am

Yes. And my curious mind is searching for studies that show hormone resistance prior to ADT. If one has a very low (relatively) PSA of 0.33 (17 yrs post RARP) with a normal testosterone of 750 ish prior to ADT, is there a chance this particular cancer is already not tracking with testosterone? Might it be a mutation or have already become a neuroendocrine tumor by natural progression over those 17 yrs? Especially, given PNI from the surgical pathology? I find I just have more questions when the answers don’t quite fit.

We are in this window just before starting triple therapy most likely, so looking for some certainty prior to going down the slide, I guess.

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