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Pre radiotherapy hormone treatment

User
Posted 18 Mar 2023 at 18:55

My understanding is that you me of the aims of hormone treatment is to reduce the level of testosterone. Is a test given to check your level before treatment starts? The reason I ask is that  at 74 I have little if any sex drive. I have not had sex with my wife for about three years partly because she has physical issues. Neither can I stimulate myself. It’s not just that I can’t get an erection, I just don’t have the urge. So I wonder if my testosterone is already low.

User
Posted 19 Mar 2023 at 22:15
I asked for my husband to have a testosterone test before starting treatment, I was told it wasn’t necessary. Really wish I had pushed though as would like to know if it is now back to what it was before HT.
User
Posted 20 Mar 2023 at 07:54

Testosterone is not routinely measured before HT (except one or two centres which always measure Testosterone when measuring PSA), although a clinician involved with dealing with the after effects of treatments says he wishes it was always measured, so he knows what level it should be going back to after treatment. (There's a large normal range, but any one person's Testosterone doesn't vary that much, so one person's normal can be very different from another person's normal.)


PSA is sometimes measured before RT, and what's important is that PSA has come down. If it hasn't, then Testosterone might be measured to try and find out why PSA hasn't dropped as expected.


The usual period of neoadjuvant hormone therapy (i.e. before RT) is 3-6 months. 3 months was the norm, but some oncologists prefer longer for those who will be on HT for 2 or more years in total.


I asked for a PSA test when they were about to book my RT, and I wanted my PSA lower. From the rate of drop, I worked out I would need 5 months neoadjuvant hormone therapy before RT, and my oncologist was happy to oblige. He did say not to wait unless PSA was dropping quickly (which mine was) and not any longer than 6 months in any case.

Edited by member 20 Mar 2023 at 07:58  | Reason: Not specified

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User
Posted 19 Mar 2023 at 00:27

I was not tested before HT. I don't think anyone on here has been tested prior to HT, and a related topic has came up before, so I think I would have remembered if it had been mentioned. I was tested after HT as it was taking a while for my testosterone to recover.


A quick Google suggests low testosterone is reasonably common, but whether yours is low and so low that HT would not be needed is another question.


I think you should ask for a testosterone test, or possibly pay for one privately (about £40).

Dave

User
Posted 19 Mar 2023 at 00:48
I am pretty certain that at one time it was the case that some men were told that their RT would not be started until their testosterone had dropped to or near castrate level, maybe a query due to PSA level. However, I appreciate circumstances are rather different here. This was sometime ago and the thinking may have changed by now. I believe Lyn among a few others may recall.
Barry
User
Posted 19 Mar 2023 at 01:58
Der wanderer,
it would be interesting to know what your testosterone level is but I don't think it would make any difference to the treatment plan. For prostate cancer, having low testosterone is not good enough - you have to be at or below castrate level and my guess is that, despite the low libido, you are not at castrate level as you are not growing breasts or showing any other physical signs?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 19 Mar 2023 at 02:00

Originally Posted by: Online Community Member
I am pretty certain that at one time it was the case that some men were told that their RT would not be started until their testosterone had dropped to or near castrate level, maybe a query due to PSA level. However, I appreciate circumstances are rather different here. This was sometime ago and the thinking may have changed by now. I believe Lyn among a few others may recall.


Yes, in years gone by, it seemed fairly standard for men to have a testosterone reading before commencing HT and then periodic tests to ensure the HT was working although it seems quite rare now. TopGun, Alathays, etc seemed to have their testosterone tested at every PSA test!  

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 19 Mar 2023 at 19:55

It does seem to be the standard medical practice  (at least in UK under the NHS) to insist on many months of HT, before and after RT, irrespective of the man's existing level of testosterone (and without usually bothering even to measure it).  


This is meant to ensure 'castrate' level, rather than low level, testosterone.


However, logically, an older man whose libido and sexual functioning has disappeared (naturally) must have far less testosterone than a sexually active man of any age.  It follows that any prostate cancer he may have  - perhaps it started when he was younger - is getting very little testosterone to 'feed' it.    (Even if not quite as little as 'castrate' level.)  Therefore, he shouldn't need more than a few weeks of HT, if that.


Unless of course (a) it's just simpler to stick everyone on prolonged HT anyway;  (b) the hospital's attitude may be, you'll have prolonged HT before any RT because "that's what we do".


I gather studies have shown that reducing testosterone to castrate level makes RT more effective than leaving men with average testosterone levels.  I'm not aware of any studies which show just how much of that benefit  accrues from getting testosterone below low-libido levels, and down to sore-nipple hot-flush levels.  But other contributors to this forum may have more information. 


 

User
Posted 19 Mar 2023 at 22:15
I asked for my husband to have a testosterone test before starting treatment, I was told it wasn’t necessary. Really wish I had pushed though as would like to know if it is now back to what it was before HT.
User
Posted 20 Mar 2023 at 07:54

Testosterone is not routinely measured before HT (except one or two centres which always measure Testosterone when measuring PSA), although a clinician involved with dealing with the after effects of treatments says he wishes it was always measured, so he knows what level it should be going back to after treatment. (There's a large normal range, but any one person's Testosterone doesn't vary that much, so one person's normal can be very different from another person's normal.)


PSA is sometimes measured before RT, and what's important is that PSA has come down. If it hasn't, then Testosterone might be measured to try and find out why PSA hasn't dropped as expected.


The usual period of neoadjuvant hormone therapy (i.e. before RT) is 3-6 months. 3 months was the norm, but some oncologists prefer longer for those who will be on HT for 2 or more years in total.


I asked for a PSA test when they were about to book my RT, and I wanted my PSA lower. From the rate of drop, I worked out I would need 5 months neoadjuvant hormone therapy before RT, and my oncologist was happy to oblige. He did say not to wait unless PSA was dropping quickly (which mine was) and not any longer than 6 months in any case.

Edited by member 20 Mar 2023 at 07:58  | Reason: Not specified

 
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