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Oestrogen and PSA readings

User
Posted 23 October 2016 12:05:31(UTC)

I've heard that oestrogen, taken as a cross -gender hormone for male to female HRT, can lower PSA readings.

In other words, I presume that a  ( pre- gender reassignment surgery) transgender woman, who, post -prostatectomy,  embarks on HRT, will not be able to rely on changes in PSA reading as part of regular post prostatectomy monitoring. 

I will put this question to the PCUK nurses, as my surgeon seems rather dismissive of any other narrative to prostatectomy than "how's your impotence/incontinence". In the meantime, maybe someone reading this has already faced this situation...

Thanks.

User
Posted 24 October 2016 07:45:21(UTC)
Nobody should be relying on PSA readings. But changes in PSA may be significant. You oncologist is much more likely to have an answer than your surgeon, but while the PSA baseline may be different, changes will still be apparent.

I hope that helps!
.

-- Andrew --

"I intend to live forever, or die trying" - Groucho Marx
User
Posted 24 October 2016 08:00:08(UTC)

Thanks for the input Andrew. I think you're  correct when you say an oncologist is more likely to know about this than a surgeon. But as I've never seen an oncologist, I'd first have to get a referral, wait a long time, all to (possibly) get a useful answer to a single question.

I'm not sure what you mean about PSA. Surely the changes and trends in post prostatectomy PSA are the earliest indicators that all is not right and further investigation is indicated. I think that this is what they mean by biochemical recurrence. Often the individual with biochemical recurrence is otherwise symptom free.

Perhaps you mean looking at trends in PSA. Well, what if I had a PSA of 0.1 post op, took oestrogen, which knocked back the PSA to 0, but on subsequent testing in the years ahead, it began to rise to '0.1' only when the PSA would actually have been 2.5, had I not taken oestrogen?  

The cancer is the thing to keep track of, and PSA is the tracker, but if the tracker's not reliable under certain circumstances, then metastatic symptoms might be the first thing noticed.

Waiting 'til other things become apparent would be leaving things rather late.

User
Posted 25 October 2016 09:16:30(UTC)

PSA is unreliable, even in people with diagnosed and treated PCA.

It should never be used for its 'absolute' value, but changes - especially trends, as one test could be misleading - can serve as a warning, and extreme changes are certainly a big red flag. It isn't a tracker, in that two people with a similar tumour could have wildly different PSA. Two people, one of whom has metastatic spread, one doesn't, could have the same PSA.

But done regularly, a rising trend certainly suggests a need for further investigation, but that's all.

There's a real danger in letting yourself think it's like haemaglobin, blood sugar, whatever - a lifetime of avoidable anxiety!

I would certainly argue for regular PSA tests for people with cancer. But I'd strongly advise against ever assuming it's reliable. Because it isn't.

Sadly, being 'body-aware' and acting fast on anything odd, painful or unexpected is probably more important. I'd hate to hear anyone say "I've got this nagging pain, but my PSA is OK"

.

-- Andrew --

"I intend to live forever, or die trying" - Groucho Marx
User
Posted 25 October 2016 10:10:23(UTC)

Originally Posted by: Online Community Member

"PSA is unreliable, even in people with diagnosed and treated PCA.

it should never be used for its 'absolute' value, but changes - especially trends, as one test could be misleading - can serve as a warning, and extreme changes are certainly a big red flag. It isn't a tracker, in that two people with a similar tumour could have wildly different PSA. Two people, one of whom has metastatic spread, one doesn't, could have the same PSA."

........I guess I'm not explaining myself clearly enough. I'm asking a specific question relating to my circumstances, which I thought I'd given. I'm not talking about two people. I'm not trying to prove that I am indisputably correct in the term 'tracker' . We can debate the meaning of 'tracker' -a crude  and fallible indicator, if you like.  Are we not monitored regularly for trends in PSA ( allowances made for blips etc)? You say something akin to this:

"But done regularly, a rising trend certainly suggests a need for further investigation, but that's all."

"There's a real danger in letting yourself think it's like haemaglobin, blood sugar, whatever - a lifetime of avoidable anxiety!"

........PSA is PSA, I'm not letting myself think it is anything other than PSA.  Production of antigens varies. PSA is not in direct relation to the growth/presence of cancer, but it is used as PART of the diagnostic picture, and post -operatively ( recall, that is my situation) it is all that is ROUTINELY monitored. We can argue the value of that monitoring, but again, that is not what I am asking. I think we can agree that things 'upset' the PSA readings in THIS scenario. A blip can be argued to be the result of something outside of prostate cancer dynamics. But Oestrogen administration would not be a blip, it would likely be for life. 

.......I have already tried to explain, offering a scenario where regular use of oestrogen knocks back the PSA levels to the point where cancer may develop without a tracker ( or crude fallible suggester of something awry, if you prefer) to make it known. Of course, we can say that PSA will not indicate cancer development ( in THIS scenario)  for definite. But in the absence  of better prognostics, I'd like to exploit the partial knowledge that regular monitoring might provide. It may well be that, with oestrogen, all bets are off, and PSA monitoring is entirely useless.  After all, this would be oestrogen not released at a steady state into the body, and itself only monitored to the point where a satisfactory level in blood is achieved at the time it is monitored.

"I would certainly argue for regular PSA tests for people with cancer. But I'd strongly advise against ever assuming it's reliable. Because it isn't."

.......See above.

"Sadly, being 'body-aware' and acting fast on anything odd, painful or unexpected is probably more important. I'd hate to hear anyone say "I've got this nagging pain, but my PSA is OK"

.......See above.

 

User
Posted 25 October 2016 13:07:12(UTC)

Hi Patrick,
I think the problem is that very little has been done up to now to begin to understand the PCa journey for transgender folk or those in transition. As you will know, oestrogen is still used as a treatment for PCa in some circumstances so any oncologist (if he could be bothered - how frustrating for you) should be able to discuss with you what the impact is likely to be for you. PCUK are also beginning to get their heads around this topic so a call to them is a good idea - they may also know of an oncologist developing expertise in transgender issues?

I think what Heenan was trying to say was that sometimes an inexpicable fall in PSA is also a very serious red flag. This needs to be considered as part of your ongoing care.

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


Thanked 1 time
User
Posted 25 October 2016 15:10:41(UTC)

Thanks, Lyn

I've already emailed the Specialist Nurses at PCUK and am waiting for a reply . I'll post the relevant info' when I get it. 

From what I've gathered, although oestrogen is used in the treatment of cancers, it can also cause some prostate cancers to grow. I'm not aware of any tests which would give a patient that information. 

I did come across 1 paper which stated that there have been no recorded cases of transgender HRT causing prostate cancer. I guess that only tells us that the research isn't there.

Looking at the endocrinology, not every transgender woman starts on HRT with the expertise of an endocrinologist specialising in transgender health. Transgender women may be managed with post-menopausal levels of hormones, some with pre-menopusal levels as the goal.  Some women will argue that they require supra physiological levels of oestrogen to achieve their desired characteristics. Others still will do things entirely DIY , using online pharmacies and never seeing a specialist. To complicate matters further, whereas drugs such as spironalactone were once prescribed alongside oestrogen, increasingly , there are transgender women who are on cross gender hormones only.
Added to this is the experience that some individuals require much more oestrogen than others to achieve the same blood levels, and that  any given level does not result in a standard level of feminisation.  
And if you thought that wasn't complicated enough, there are the different methods od delivering oestrogen to the body-e.g.  transdermal patches, i.m. and subcutaneous injection at various different body sites, gels, sublingual and oral pills. It is not surprising, given all the various pathways in the body that are governed by hormones, that doctors are risk averse and prescriptions are sometimes at the minimum level possible, rather than any feminisation, the level given is just designed to ward off osteoporosis.

I suppose given the relatively small population of transgender women, and all these variables, it is hardly surprising that there is a lack of good research data.

 

 
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