Slow testosterone growth

You mentioned that you had the ATM gene mutation, but when listing the many treatments you’ve had, didn’t mention whether you had tried one of the PARP inhibitor therapies for ATM mutations.

Also, which isotope therapies and immunotherapy/checkpoint inhibitor therapies have you tried?

If it were me, I would exhaust those options before considering an orchiectomy.

@brianjarvis

Thank for answer.

No, my oncologist sad me than PARP too early to apply and I dont have any isotope therapies and immunotherapy/checkpoint inhibitor therapies

Now I have only ADT + Erleada after 8 courses Docetaxel. That it, only.

My doctors is not right or do they just not care about me?

I can’t believe your doctor would tell you that if your testosterone rises above such a minimal level, you need your testicles removed. I have never heard of anything even close to that. As long as your testosterone is below five it is just as effective as being below 1.7. I would ask the doctor to show you documentation that would justify needing the removal of the testicles. Taking Erleada blocks androgen (male hormone) receptors on prostate cancer cells, preventing testosterone and other androgens from fueling cancer growth. So having a low testosterone level is not so critical while you’re on that drug (or on Nubeqa).

One major study, the stampede study, looked into the rise of testosterone and many other issues, it showed if it rose over 50 that was a problem not 1.7.

You are beyond the expertise of a urologist you should be going to a center of excellence and getting treatment from an Oncologist that specializes in prostate cancer.

Instead of diphereline 3.75. You should ask the doctor about putting you on Orgovyx, A pill you take once a day that’s much easier than getting an injection. It is just as effective.

Another thing you should request is switching Erleada (apalutamide) to Nubeqa (Darolutamide) because it has a fewer side effects and works just as well. It also doesn’t pass the blood brain barrier, which can cause brain fog.

@denis76 Very broadly, to quality for isotope therapy (Pluvicto in this instance), requires:
> a positive PSMA PET scan to confirm cancer cells have the PSMA target.
> Metastatic prostate cancer (usually hormone resistant PCa, but more recently hormone sensitive PCa also).
> Failed Other Treatments (Generally refers to patients who still have cancer after trying surgery and/or radiation, ADT, ARPI, and chemotherapy.)

That’s it. You need to ask why Pluvicto (Lutetium-177) hasn’t been offered to you.

Xofigo (Radium-223) is another isotope therapy, but it’s only for bone metastasis.

225 PSMA Actinium is another isotope therapy, but I don’t know if it’s FDA-Approved yet.
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I don’t know when the right time is to use PARP therapy - like lynparza (olaparib) or talzenna (talazoparib). But, if it were me I would ask for an explicit and precise answer to “When?”

Similar question regarding immunotherapies/checkpoint inhibitor therapies - Are you a candidate for those therapies?

You have many questions to ask - and many answers to get - before you need to resort to radical treatments.

@jeffmarc

Oh, Jeff. Thanks for reply!

Nubeqa and Orgovix not available for me (according to the conclusion of the medical council, Erleada, Diphelerin, and Zoladex were prescribed)

Almost all metastases have been destroyed by chemotherapy or are dormant. My oncologist says that if my PSA is 0, then "there's nowhere to shoot," BUT, the expression in the tumor itself remains (this info on January 2025 before Erleada). I'm concerned that after six chemotherapy sessions and ADT (Zoladex 10.8), my PSA only dropped to 12. After two additional chemotherapy sessions, it dropped to 8. I understand that after a PSA of 531, it was difficult to lower my PSA. In other words, it didn't drop to 0. It was after this that Erleada was prescribed, after I pushed the doctors hard!

In January 2025, my PSA was 6.9, testosterone 1.13 (before Erleada).
In February, I started Erleada and replaced Zoladex 10.8 with Diphelerin 3.75, as recommended by my oncologist.

In March 2025, PSA 1.21, testosterone 1.36
In August 2025, PSA 0.12, testosterone 1.55
In November 2025, PSA 0.04, testosterone 1.61 (after taking Erleada and Diphelerin 3.75 after 9 months)

Even here on the forum I read a lot about the fact that the lower the testosterone level, the better and this level should not be higher than 0.7 to exclude risks with Gleason 9

By the way, I should mention that I had high cholesterol, very high – 8.

I started taking statins in October 2025 and lowered it to 4. Perhaps this affected the growth of testosterone; in 3 months (I repeat), it increased slightly by 0.06 I mention this because testosterone synthesis depends on cholesterol, and there are heart risks. There's some information that lowering cholesterol leads to lower testosterone levels. Have you seen this information?

Thank you so much for participating in the discussion, Jeff.

@denis76
What country do you live in?

I know that both of those drugs are available in most provinces of Canada.

@brianjarvis

Thank!

Lutetium-177 and Radium-223

My oncologist said that isotopes will be used when metastases appear, which is strange.

@jeffmarc

Russia 🙁 The treatment standards here are different. They wait for the PSA level to rise and then inject it with isotopes.

@denis76 When was your most recent PSMA PET scan?

@brianjarvis

January 2025