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testerone replacement

User
Posted 02 Jul 2023 at 11:47

I'm wondering if it's possible to have testosterone replacement after Brachytherapy?

I was diagnosed with localised intermediate prostate cancer Gleason 3+4, T2A/B in March 22. In Sept 22 I underwent LD 4d Brachytherapy at Guildford.

My PSA had dropped to 2.2 by Nov 22, and on May 23, it was 0.6; I'm hoping that by the next test on Aug 23 it should be nearly zero.

My libido seems to have suffered following this treatment, I have little desire for intercourse, and I have difficulty getting an erection, although I haven't tried the pills.


If my testosterone level has reduced sufficiently following the next test in August, whether the doctors would be willing to prescribe testosterone replacement?

I know that testosterone is a key driver of prostate cancer. However, I have read that some patients can receive testosterone replacement once their cancer is in remission.

I'm just wondering if anyone in a similar position has received testosterone replacement after the cancer is in remission?

User
Posted 02 Jul 2023 at 12:42
Hi Sunnyjim,

it seems from your bio and previous posts that you have not had hormone treatment alongside the brachytherapy so how do you know that you have low testosterone? Have you had your testosterone measured? Brachytherapy does not affect testosterone levels at all so, unless you already had low testosterone, your symptoms are probably caused by the brachy and / or the worry of being diagnosed with prostate cancer.

As you still have a prostate and do not seem to be on HT, you may not get down to an almost zero reading - 0.6 is an excellent result for your treatment.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 02 Jul 2023 at 14:25
We don't know whether low testosterone has been established by test or has been assumed due to lack of libido etc, so if the former has not been done it needs to be. If it is established that testosterone is low, it would be worth discussing testosterone augmentation with your Oncologist as increasing testosterone may or may not provide food .for any remaining cancer cells
Barry
User
Posted 02 Jul 2023 at 17:32
Thanks for the replies, and in answer to the points raised:-

- I haven't had my testosterone measured, but I was going to mention it to the doctors in August when I get my PSA results

- my treatment was brachytherapy alone with no HT

My question was really whether its possible to have testosterone replacement after brachytherapy in situations where its established that testosterone is low and that the PSA has been lowered to a sufficient level for the doctors to be happy.

For LynEyre, I'm glad that you think my outcome so far is excellent, its been 10 months since I had my treatment, and my consultations following treatment have all been by phone, so not much chance to communicate all my thoughts and feelings, I guess the consultants are all snowed under with work at the moment.

For Barry, yes I will discuss testosterone augmentation at my next appointment, get some tests done and see what they think. I've read that some oncologists aren't keen for fear of stimulating the cancer again but I wasn't sure if this would apply to me since I didn't need HT.

User
Posted 02 Jul 2023 at 18:55
I think the best thing will be to ask for a testosterone check with your next PSA test so that you have the result before you see the oncologist in August. Without evidence that your T is low, all the onco will do is suggest that you see your GP to get your testosterone measured and then seek a referral to urology if it is low - a long drawn out process.

If your T is low, there is no clinical reason why you couldn’t have T-therapy to bring it up to a normal level; men who usually have normal testosterone levels are not precluded from having mono-brachy and men on curative RT (including brachy) are not kept on HT for life. You are right that some oncos would be reluctant but common sense should prevail.

Anything less than 2.0 is a good result post-brachy so you are doing very well.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 03 Jul 2023 at 15:11

For men who have finished treatment for prostate cancer, and which appears to have worked with no evidence of disease, if they are low on Testosterone, then treating this does not appear to increase risk of prostate cancer recurrence. There is even the suggestion from some places that low T (but not as low as hormone therapy levels) could be a contributory factor for prostate cancer.

This is a relatively new finding, the mantra for years having been, no you can't have TRT (Testosterone Replacement Therapy) if you ever had prostate cancer. However, you will certainly need your PSA regularly monitored (as well as your T).

As a former prostate cancer patient, you will probably need to be referred to an andrologist to investigate this properly, and they should ask permission of your oncologist before treating. Low T is not simply a matter of measuring T levels, because the right level varies, anything from about 8nmol/L to 26nmol/L in different people but fairly constant in any one person. I spoke with someone who is suffering with low T symptoms, and he is around 10 or 11nmol/L. While that might be within the normal range, his Luteinising Hormone and FSH levels are very high, which means his brain is trying unsuccessfully to raise his T level higher, so his normal is indeed higher than 10 or 11, whereas that level might be normal for someone else. In this case it's due to damage to testicles, and they are generating the max they can. The wide range of normal level is because different people have more or less sensitive androgen receptors. If you have more sensitive androgen receptors, your normal T level will be lower. However, there is often a gradual drop in T levels with age, and being overweight also drops your T levels because Aromatase enzyme in body fat converts T to estrogens (female sex hormones), so the more body fat you have, the more of your T gets converted to estrogens. That not only loses you some T, but estrogens suppress the generation of T in the first place, so that's a double whammy.

User
Posted 05 Jul 2023 at 14:40

Had HT, RT and brachytherapy for Gleason 7 cancer finishing in 2018.   My testosterone levels are low 2.02 nmol/L in 2021.  PSA consistently below 0.1.  Suffer from hot flushes and sweats.  My oncology team refuse to consider HRT stating that it is too dangerous.  There must be a safe level of testosterone for me and from this topic there seems to be a case for HRT so how do I proceed?

User
Posted 05 Jul 2023 at 17:22

It seems like your oncology team is out of date, unless they think the treatment hasn't cured you.

In any case, it's an Andrology department which would handle low Testosterone, but they would consult your oncologists.

User
Posted 05 Jul 2023 at 17:51

How do I move forward, who would refer me to Andrology?

 
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