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Post-treatment testosterone
I was G7 (4+3) and treated two years ago with five sessions of SBRT, two months of doublet therapy and then four months of Orgovyx ending in 10/2024. My PSA has been undetectable for a full year.
My pre-treatment testosterone was in the mid 500s. Three months after stopping, it reached ~350 but has been bouncing around since and is now 260.
My GP says TRT is a hard “no” after prostate cancer. My sexual health doctor says it’s fine and he’s seen no difference in recurrence between those who do and don’t supplement. My oncologist says it’s up to me.
My urologist has the most nuanced opinion. He thinks supplementation is OK but questions if it’s needed. He thinks I should go by how I feel and not just a number from a test and emphasizes that T is not a miracle drug that will “make you feel 25 and solve all your problems” despite online advertising claims.
My libido is the same as pre-treatment and sexual function is good with 20 mg Viagra. I have no trouble exercising. My mental state is decent. I have mild radiation cystitis, but I don’t think T helps that.
My nagging fear, though, is that having relatively low T is damaging me in some way I’m not aware of despite how I feel and that eventually something awful will happen as a result.
I’m leaning towards waiting the full two years to see what happens. Anyone faced a similar choice? How did it work out for you? Thanks!
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As I recall, the biggest side-effects of low testosterone are sexual dysfunction, unintended weight gain, bone-density loss, muscle-density loss, and elevated HbA1C (indicating progression towards type 2 diabetes).
You can monitor all of these, and if you don't find any problems, then there's nothing you need to fix.
Some people have that amount of testosterone their whole life. The fact that you’re not noticing anything problematic makes a lot of sense since the amount of testosterone you have is more than enough to prevent any of the side effects from ADT. Is your oncologist a Genito urinary oncologist? They are the ones that specialize in prostate cancer, unlike medical oncologist, that specialize in all different types of cancers, and can’t really keep up with everything going on in prostate cancer.
Boosting up your testosterone can definitely cause problems. If you do decide to do that, you should get PSA tests regularly, No less than every three months, maybe even every month for a few months. If your PSA does start to rise, you have to realize that that means going back on Orgovyx, And definitely for a longer time than you did the first time.
Another thing you have to realize is that when you get prostate cancer, it sends cancer cells all around your body Before it is even detected.. They become dormant and can’t be detected by any technique they currently have. When you have a lot of stress in your life, the cancer can come right back as those dormant cells become active.
This was discussed yesterday‘s PCRI conference. Dr. Kwon Was asked if prostate cancer spread was like a pebble going into a body of water and spreading out in waves. He said no, Prostate cancer spreads in a stochastic spread that goes everywhere. He wasn’t even discussing the dormant problem. A big boost in testosterone can activate those cells that have spread.