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My first PSA test three months after having HIFU treatment has come up with an encouraging figure of 0.4, despite the fact that I had focal treatment and therefore have prostate tissue remaining. In e-mail correspondence with a friend, who also has PCa, I mentioned that I am taking into account the fact that I had three months of hormone therapy which finished at the end of September 2009, and the after effects of this could still be affecting my PSA reading.
I do not have a copy of Dr. Patrick Walsh's book 'Surviving Prostate Cancer' but my friend pointed out to me that on page 246 Dr Walsh writes "...another extremely important fact...about hormonal therapy: It is effective only while a patient is on it. The day you stop taking it is the day it stops working."
Now, Dr Walsh is an expert; I am not. However, much of what I have read at various forums and from other sources, has led me to believe that it takes time - sometimes many months - for testosterone to revert to the level it was prior to ADT. I read about instances of people who have been on ADT for longer periods than I was, taking perhaps 12-15 months to regain a reasonable testosterone level. As the reason in the first place for reducing testosterone levels is to inhibit the growth of tumours, I would have thought that as long as testosterone levels remain low, the inhibitory effect would continue?
Additionally, I know of at least one trial in the UK where patients are not eligible if they have had hormone treatment within six months of the start of the trial, because it is deemed that this could skew the figures.
In my case, my hormone treatment was administered as a three-month injection, as opposed to tablets (which I assume Dr Walsh is referring to), and it seems unlikely that there would be a precise cut-off point at the end of the three-month period. If libido, or lack of it, is any indication, my testosterone levels did not start to recover until about 3 months after the end of my period of hormone treatment.
I will be interested to hear the comments of others on the subject.
I think it is important to bear in mind that Dr Walsh is a surgeon, not an oncologist and has demonstrated over the years that as far as he is concerned, the only reaction to a diagnosis of prostate cancer which is “curable” is surgery. The fact that most “curable” tumours probably do not require immediate treatment does not feature in his world.
So anything he says should be viewed through this lens.
There is ample evidence that the reaction of men to ADT (Androgen Deprivation Therapy), including the time it takes to recover from the effects of the treatment is widely variable.
Before I was able to take place in the Abiraterone Acitate plus Prednisone Trial, I was asked to cease taking Cosidex, which I had been taking for approx 3 years. It took 3 Months to flush the cosidex from my body enough to start the Trial. I have been on Lucrin (Lupron) for almost 7 years and I was told to continue to have my 3 Monthly shots, whilst on the Trial. I know that the Cosidex has mostly gone, because the side effect of very sore nipples, has now ceased and they are are back to normal.
But as Terry has pointed out, we are all different and also the amount of time you have been on the medication could possibly have some effect on how long the medication takes to be flushed from their system.
Here is my understanding of what is going on. Both Casodex and Zoladex clears the blood in a few days. The effect of these drugs can last forever but the LHRH is typically a year (after 2 years use) and Casodex seems to be about 3 months (from the above comment). These drugs act by filling the receptor sites and then will detroy them. Your body has to regrow these receptors, if it can, before your testosterone will start to go up in level (LHRH) or the testosterone can be made use of again (Casodex).
At age 56 and after 2 years of Lupron, my testosterone level began to rise 6 months after cessation of the drug. By one year after cessation T levels were normal. The "no rules" applies again. I'm now 57 and still have some soft tissue damage from the radiation but judging by my other "symptoms", I am one of the lucky ones although the use of ED medication definitely improves the experience.
My understanding is that it takes at least 3 mos. after cessation for the pituitary gland to start stimulating the testes to produce testosterone and T level is totally unpredictible depending on the individual. - p (Alaska, USA)
Many thanks for your comments. Overall, I am inclined to think that the good doctor meant well but, in this instance, has probably got it wrong.
My own experience, combined with the comments I hear and read from others, leads me to believe that testosterone levels will usually take some time to recover following the end of ADT. On the basis that lowered testosterone will, in most cases, have a limiting effect on tumour growth and probably on PSA readings, it seems likely that these two things may be affected for some time after the end of treatment.
Hi Jeremy,
Hope you're well. My Casodex has led to very sore nipples. My surgeon said that even after I cease Casodex (some time after my HDR and EBRT) I can expect 3 months before the side effects go. Thereofre it's reasonable to assume, as you've done, that the lowering effect on PSA may also continue for up to 3 months.
But don't let that diminish your enjoyment of very low PSA for a man with a largely intact prostate!!
