Testosterone Therapy after Prostate Cancer

[madman]

TESTOSTERONE THERAPY IN MEN ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER (2022)
Jose M. Flores, Carolyn A. Salter, Nicole Benfante, Lawrence Jenkins, Behfar Ehdaie, Vincent Laudone, James Eastham, and John P. Mulhall


Abstract

INTRODUCTION AND OBJECTIVE:

The role of testosterone therapy (TTH) in men with prostate cancer (PC) is debated, especially in men on active surveillance (AS). This study aimed to review our data on TTH in this population.

METHODS:

The study population consisted of (i) men with PC on active surveillance (ii) with two total T (TT) levels <300 ng/dL (iii) associated with symptoms (iii) performed using LCMS (v) conducted in an early morning fashion who (vi) pursued T therapy (TTH). TTH included exogenous (transdermal, intramuscular) and clomiphene citrate (CC) in the setting of low/low-normal LH levels. T lab work including PSA levels was checked within 4 weeks of TTH initiation, every three months in the first year, and every six months after that. Target TT level was the middle tertile of the normal reference range at our institution. We report on T and PSA levels in this group.

RESULTS:

82 patients are included. Mean age = 64 ± 9 years. Median pre-TTH PSA levels were 4.6 [3.4, 6.7] ng/mL. Mean baseline TT levels were 305 ± 145 ng/dL. 19% of these men had a TT level <200 ng/dL. Median Gleason score (GS) was 6 with 90% 3+3, 9% 3+4 and 1% 4+3. The median duration on AS before TTH was 14 [1, 43] months. 45% received transdermal T, 19% intramuscular T, and 36% CC. Post-TTH TT = 553 ± 268 ng/dL, PSA = 4.9 [3.2, 9.2] Median duration of TTH at last follow-up was 14 [1, 39] months. Median PSA change per patient was 0.3 [-0.9, 2.6] ng/mL, representing a median of 14 (-24, 70) % change in PSA per patient (p= 0.045). 42% had a decrease in PSA, 58% an increase. In 88% of men who experienced a rise in PSA, the PSA rose ≥10%. 50% of men on TTH who had a PSA level below 4 ng/dL rose above 4. 28% of men experienced a PSA level increase ≥1 ng/mL per year. In 18% of these men, TTH was stopped and definitive PC treatment was instituted. In men with ≤1 ng/mL per year increase in PSA, another 18% opted for definitive PC treatment. The most common reason for this was PSA anxiety.

CONCLUSIONS:

In men with PC on AS treated with TTH, minimal changes in PSA were seen, with equal numbers of men experiencing a rise and a drop in PSA. About a fifth of men ceased AS and proceeded to definitive therapy for their PC.

 

[Ozzieville]

Thanks for sharing that study, Nelson. Since PSA levels tend to rise over time anyway, it's remarkable that half the men had a PSA drop while on TTH.

As I've noted, in my own case, at the time of diagnosis with prostate cancer three years ago, my PSA was over 4. Now, after three years on active surveillance and two years on TTH, my PSA is below 4.

 

[Boshog]

Last year my PSA was 5.3 and now is at 4.1. My focus has been on improving general health and nutrition. On TRT the entire time and visit the urologist every 6 months.

 

[Ozzieville]

Boshog: has your urologist recommended an MRI or prostate biopsy? Typically a PSA of above 4 is the trigger point (was for me).

 

[Jed Dorsey]

Thanks for sharing that study, Nelson. Since PSA levels tend to rise over time anyway, it's remarkable that half the men had a PSA drop while on TTH.

As I've noted, in my own case, at the time of diagnosis with prostate cancer three years ago, my PSA was over 4. Now, after three years on active surveillance and two years on TTH, my PSA is below 4.

What’s your Gleason score?

 

[Jed Dorsey]

In my experience PSA rises in correlation with T dose. When I was diagnosed with PCa about 4 years ago my PSA 8.8 my urologist scheduled MRI and biopsy it came positive with very low grade PCa known as Gleason 6. I stopped my TRT for a year and half and PSA dropped back to 2.5.
I was approved back on to TRT and I started at 125 mg 1x week and PSA jumped to 3.0 I increased again to 140mg per week PSA climbed to 3.5 I increased again to 160mg and now it’s at 4.1. I don’t think the rise in PSA is due to cancer progression but simply a reaction of my prostate to the added androgens for which I’m also on 200mg Nandrolone for joint pain.
I’m confident of my PSA for two reasons 1. I’ve had two MRI and biopsies in the past one year apart and the first positive for G6 cancer and the second came out negative for PCa. 2. I’ve also learned that when cancer is progressing in the prostate PSA doubles after frequent checks.
Good luck gentlemen

 

[Ozzieville]

Jed, you're lucky to have Gleason 6. As you may know, there's a movement to reclassify Gleason 6 as a non-cancer, since it's invariably indolent.

I was diagnosed with Gleason 7 (3+4), which is considered favorable intermediate.