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Old 12-21-2010, 07:22 AM   #1
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Question Testosterone and Prostate Cancer - Possible?

I wanted to give a little background before I asked my question.

In December of 2009, I received a call from my PCP that my PSA had come in at 10.5 and he wanted me to see an urologist immediately. I was taken by surprise and asked what the level was in earlier tests. He could not find any record of the test being done although I always remember asking for the test since I am in my early fifties. Ok, for whatever reason, I think cost, the test was never done before.

I made the appointment for the urologist and during that appointment we went over my history. No history in my family for prostate cancer. He took another blood sample and the PSA was 11.7. He also precribed some anibiotics and I had the test done after I finished that course of medication. It brought my PSA down to 5.7 but not enough so a biopsy was scheduled. At this point, we are in the beginning of 2010. The biopsy came back and out of 12 samples, 1 showed signs of cancer with a Gleason score of 6 (3+3).

I did my internet research and knew some of what to expect. The urologist said I had a few options. A wait and see approach, radical prostatectomy, radiation by insertion of radioactive seeds into the prostate or radiation of about 45 visits. After thinking long and hard I chose the seeds and was scheduled for surgery in April of 2010. I did all the pre-op steps necessary and was in the pre-op area getting everything ready to go, including the IV administration of a sedative. I was wheeled into the operating room and place on the operating table. I felt calm and not nervous since I've had surgery before and had a surgical team all around me. I was given another dose of sedative which I thought was strange since I was already calm and could see my pulse rate was already low as well as blood pressure.

A few moments after that, I could see panic in the eyes of some of the staff and the anesthesiologist said to me "Well, if this was going to happen, this is the best place to be!". I didn't understand but thought well yes, surgery and an operating room go hand in hand so sure, this is a good place to be. What was really going on was that my heart had stopped. They pushed epinephrine and my heart started to beat again. I was aware of everything and could recount everything that transpired after the incident. The surgery was called off and after a battery of tests (x-rays, blood work, sonigram, EKG etc) I was kept overnight. I felt fine and would have preferred to go home but was advised against it. The next day I was discharged.

I went to see cardiologists and did a complete stress test and wore a monitoring device for the next thirty days. What was really concerning me was that I am dedicated to the gym and worked out 6 days per week, both free weights and machines and also a good amount of cardio. At this age, I was in the best shape of my life!

At the end of all of this, I was cleared for surgery by cardiology but the oncologist and urologist would not touch me for surgery. OK, next choice is radiation but there is an experimental radiation beam therapy that only requires 5 treatments. I opt for that and it is scheduled to commence in June. The treaments are twice a week for two weeks and one time the third week. I have had two PSA tests since then. The first was 1.7 and the second came back at 0.3. I am very hapy with the outcome and thankful to be in this position.

On the downside, the side effects are dreadful - ED, tiredness, concentration issues, strength issues, incontinence (although that is improving) all of which are very disconcerting. I had my testosterone levels checked as well and they are alarmingly low.

Finally, my question, is there ever any case when it is OK to improve the quality of life with testosterone therapy. What are the trade-offs and risks?

 
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Old 12-21-2010, 09:28 AM   #2
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Re: Testosterone and Prostate Cancer - Possible?

Hi Brian,

Your case history is impressive. You have leaped in two years what many would experience in a decade. I wish you the best in this new adventure you are to embark on.
In this forum there is a thread named "Testosterone Replacement Therapy for Prostate Cancer Survivors”, answering exactly your question. I believe you will find it very instructive for a conclusive decision.
Welcome to the board and have a Merry Christmas.

Baptista

 
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Old 12-21-2010, 05:15 PM   #3
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Re: Testosterone and Prostate Cancer - Possible?

Low testosterone (hypogonadal) is actually associated with more aggressive disease. There is no evidence that testosterone replacement to normal levels causes early stage disease like yours to progress more quickly. As long as you monitor your PSA, what possible harm could there be?

It sounds like you have decided on CyberKnife, which is what I had (I had 8/17 cores positive). Remembering that early stage PC is a very slow-growing disease, and seeing how little of it you have, have you considered Active Surveillance, until your PSA indicates that treatment is warranted? It's just a matter of what you personally can live with.

I've gotta say that yours sounds like the classic case where a biopsy should not have been done. Half of middle-aged men have PC, and there is no reason why most of us should not live for many years without the side effects of treatment.

- Allen

 
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Old 01-09-2011, 07:18 AM   #4
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Re: Testosterone and Prostate Cancer - Possible?

Brian:

From your 5 treatment radiation schedule it sounds like you are going for CyberKnife, which I had Feb. of last year. You will be pleasantly surprised by the comfort of the procedure-it's almost a non-event. I am in a (now closed) study that so far has shown very positive results. One of the factors that they are following is testosterone level. I don't know any data about or reason for that part of the study but I am scheduled to meet with my Radiologist this Feb. for my 1 year checkup and I will ask about it at that time. BTW, my PSA at the 9 month interval had dropped from 8.0 to 2.1. It will be interesting to see what my Feb. blood test reveals. I feel fine and everything works as normal and I have no lingering side effects.

Bob

 
Old 01-09-2011, 08:09 PM   #5
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Re: Testosterone and Prostate Cancer - Possible?

Brian,
Dr Liebowitsz in Los Angeles and his partner have worked quite a bit with testorone replacement. There was a very detailed article about it in the last issue of PAACT. It seems like it does significantly improve the quality of life without undo risk. I would not undertake it without going to a medical oncologist that is very experienced in monitoring it.
JohnT

 
Old 01-30-2011, 06:23 AM   #6
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Re: Testosterone and Prostate Cancer - Possible?

"OK, next choice is radiation but there is an experimental radiation beam therapy that only requires 5 treatments. I opt for that and it is scheduled to commence in June. The treaments are twice a week for two weeks and one time the third week."

Ummm... I was told by my Radiologist when I requested the every other day schedule as opposed to the 5-day straight schedule for my CyberKnife treatment, that the only stipulation that she had was that the treatment schedule had to be completed in no more than 11 days. This could have been simply a study protocol requirement as I am in one, but this timing is worth checking out with your radiologist. BTW, I found the every other day schedule easy to do (I did WF,MWF) and I was glad to have it done it that way and be on my way to recovery. I had very minimal side effects. I don't think that I would have stretched it out, even if it had been offered.

Bob

 
Old 01-30-2011, 06:51 AM   #7
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Re: Testosterone and Prostate Cancer - Possible?

Quote:
Originally Posted by RJM3 View Post
"OK, next choice is radiation but there is an experimental radiation beam therapy that only requires 5 treatments. I opt for that and it is scheduled to commence in June. The treaments are twice a week for two weeks and one time the third week."

Ummm... I was told by my Radiologist when I requested the every other day schedule as opposed to the 5-day straight schedule for my CyberKnife treatment, that the only stipulation that she had was that the treatment schedule had to be completed in no more than 11 days. This could have been simply a study protocol requirement as I am in one, but this timing is worth checking out with your radiologist. BTW, I found the every other day schedule easy to do (I did WF,MWF) and I was glad to have it done it that way and be on my way to recovery. I had very minimal side effects. I don't think that I would have stretched it out, even if it had been offered.

Bob
I was in an experimental protocol as well. The results, PSA wise, were phenominal so far. 11.7 PSA to 0.3 PSA at my last test.

Thanks for the post,
Brian

 
Old 01-30-2011, 12:06 PM   #8
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Re: Testosterone and Prostate Cancer - Possible?

There is no evidence that testosterone causes or exacerbates early stage disease like yours. I'm getting some post-RT. I had hypofractionated SBRT (F,M,W,F,M).

Have you considered Active Surveillance? -- you have very little of a very slow-growing disease and your PSA is quite low.

- Allen

 
Old 02-01-2011, 05:29 AM   #9
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Re: Testosterone and Prostate Cancer - Possible?

Hi Brian,

Welcome to the Board!

Congratulations on your PSA results! Looking good!

You've already received responses that have covered the key points, but I wanted to join that chorus with concurrence.

Dr. Robert ("Dr. Bob") Leibowitz's work has already been mentioned. His "Compassionate Oncology" practice has published more than one article about their experience with testosterone replacement therapy. He has been involved with that for at least half a decade at this point.

He and some other doctors, at least one quite well known, published an article about it that you can find on PubMed (www.pubmed.gov) with this search string, without the quotation marks: " prostate cancer AND testosterone replacement therapy AND leibowitz r [au] ". If you widen the search by deleting " AND leibowitz r [au] ", you will get 205 hits. You can read each study's description of what was done and key findings (the "abstract") by clicking on the blue hypertext title. Some of the papers have a link to a free copy of the entire paper. (We can use www.pubmed.gov on this board because it is Government sponsored.)

Take care,

Jim

 
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