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Thread: Resuming TRT after RP with positive margin?

  1. #1
    Regular User
    Join Date
    Jan 2017
    Posts
    16

    Resuming TRT after RP with positive margin?

    Hi,

    I'm new here, and grateful that this forum exists.

    Three weeks post op, and very bummed by the positive margin in Px. Had to stop TRT upon diagnosis, and now am at 50ng/DL -- practically castration level. Fatigue, loss of interest, loss of libido and depression all side affects. And all of them combined depressing when it appears unlikely any doc would prescribe TRT with positive margin. Was having erectile issues even with Cialis, etc. when my testosterone was up in the 500's. Injections seem to be in my future. Ugh.

    First post op PSA will be end of May.

    Anyone have a similar experience? Anyone have any suggestions?

    Thanks.

    RAD
    Age 65
    Dx Hypogonadism 15 years ago. Treated with Androgel. Discontinued upon Dx of PCa 1/2017.
    Testosterone now 50ng/DL. Not happy.
    Fusion Biopsy 1/3/17, 7 of 13 cores positive, highest Gleason 4+3 in two cores. Perineurial invasion present.
    Pre-op PSA 4.8
    Bone Scan Negative
    Robotic RP 3/1/2017. Px: pT2c NO Mx, Bilateral tumor 5-15% of prostate, Positive Focal Margin Left Posterior,
    Gleason downgrade to 3+4, Lymph nodes and Seminal vesicles negative, P
    Dx Major Depression 2015
    5/17/2017 PSA <0.006. Continence >98%. ED present, injections Bimix, Trimix ineffective.
    8/2/2017 Penile implant LGX
    8/25/2017 PSA<0.006

  2. #2
    Hi RAD (hello also from Philly burbs):

    Sorry to hear of your situation, particularly the depression aspect. In particular, I note your listing of "major depression" in 2015, apparently related to hypogonadism. While I have no personal history in this area, my first suggestion would be to step back and look at the current big picture.

    At age 65, you are just three weeks away from having robotic surgery with a downgraded post-surgery pathology report, which for many people would be a cause for celebration, not depression. A positive margin, for most patients means virtually nothing. In your case, however, it interacts negatively with your desire to focus on your testosterone for various reasons.

    With all due respect, while certainly not an ideal situation, you have received the necessary treatment needed to preserve your continued existence. And that by itself, for a lot of patients, is reason enough to be thankful that you will not be among the 30,000 men who die each and every year in the U.S. from this horrible disease.

    To focus so greatly on the libido aspect of your case misses the point that a dead man has no need for a hard-on. If you pose the question to your significant other as to which of the two choices -- assuming only one choice can be fulfilled -- she would rather have, I feel confident that her vote would be for you to remain with us.

    Please keep in mind that your situation is not isolated. You are not alone -- many of us have ED problems but we are thankful to still be here. Yes, there are numerous options (injections, pumps, etc.) but each one is fighting a single battle in a war that you have already won. Your loved ones still have you to embrace and cherish.

    That, in itself, is enough for many people.

    I realize that I'm just one silly old man trying to reason with you but I'll be glad to buy you a beer and bore you to tears by telling you how I have found new meaning late in life by becoming a television poker semi-celebrity, winning major poker tournaments at ages 72, 73 and, just 11 days ago, at age 74. In August, I fly to Los Angeles on an all-expenses-paid package to play in a $3 million poker tournament.
    https://www.dropbox.com/s/2tgsaqzh4a...ience.mp4?dl=0

    Each of us have the ability to find ways to meaningful enjoyment.

    All the best to you, Sir,
    Jim
    LUNG
    Age: 71 -- 12/2013 - Cat Scan sees new irregular 1.8 cm nodule in right middle lobe.
    3/13/14 - PET Cat Scan confirms presence of same nodule -- same size. Nodule lights up indicating likelihood of lung cancer -- Location not conducive to biopsy.
    3/17/14 - Three top doctors say it MUST come out via a wedge re-section. If cancerous, the entire right middle lobe must be surgically removed.
    6/13/14 - Nodule shrank by 1/3. Not cancer. Surgery cancelled. Next scan 9/14. Nodule "resolved" - gone.

    PROSTATE
    Age: 67 -- 2/2010 - PSA: 4.05
    8/2010 - PSA: 4.95
    9/2010 - Biopsy - 2 out of 12 cores positive - Gleason: 3+4=7
    11/8/2010 - DaVinci RALP - small positive margin - was told it was meaningless.
    2/11 - PSA: 0.02; 8/11 - PSA: 0.04; 2/12 - PSA: 0.06; 8/12 - PSA: 0.08; 2/13 - PSA: 0.11; 5/13 - PSA: 0.16 - referred to oncology radiologist.
    9/2013: 40 sessions of IMRT salvage radiation completed.
    1/14, 4/14, 7/14, 10/14, 1/15, 8/15, 3/16, 8/16, 3/17 - All PSA: 0.00

  3. #3
    Regular User
    Join Date
    Jan 2017
    Posts
    16
    Jim,

    Thank you for talking some sense in to me. I am very grateful.

    Bob
    Age 65
    Dx Hypogonadism 15 years ago. Treated with Androgel. Discontinued upon Dx of PCa 1/2017.
    Testosterone now 50ng/DL. Not happy.
    Fusion Biopsy 1/3/17, 7 of 13 cores positive, highest Gleason 4+3 in two cores. Perineurial invasion present.
    Pre-op PSA 4.8
    Bone Scan Negative
    Robotic RP 3/1/2017. Px: pT2c NO Mx, Bilateral tumor 5-15% of prostate, Positive Focal Margin Left Posterior,
    Gleason downgrade to 3+4, Lymph nodes and Seminal vesicles negative, P
    Dx Major Depression 2015
    5/17/2017 PSA <0.006. Continence >98%. ED present, injections Bimix, Trimix ineffective.
    8/2/2017 Penile implant LGX
    8/25/2017 PSA<0.006

  4. #4
    Rad. Listen to my brother Jim215. A very well written analysis of the PCa landscape, as it pertains to your particular case. If I were standing in your shoes, I'd be having a damn party, and inviting all the guys on this site to join me. Take each day and choke it to death, none of us are promised tomorrow. Hope u are feeling better. U have much to be thankful for. Best, MM

  5. #5
    Experienced User
    Join Date
    Dec 2015
    Posts
    92
    I was on TRT ( Androgel also) when I was diagnosed. My plan is to avoid going on TRT again, but I was never at 50. That is really low. Maybe after you get some undetectable PSA tests under your belt, you could ask about going back on TRT?
    DOB: 1961
    PSA October 2015: 7.6
    DRE: Negative
    Biopsy December 2015: 5 of 12 cores positive for Adenocarcinoma
    Left Lateral Mid, Gleason score 3+4=7, 63%
    Left Lateral Apex, Gleason score 3+4=7, 83%
    Left Base, Gleason score 3+4=7, 11%
    Left Mid, Gleason score 3+4=7, 20%
    Left Apex, Gleason score 3+3=6, 99%
    Right Lateral Apex, HGPIN
    RALP on March 18th, 2016
    Prostate weight 37.5 gr, tumor involvement 40%
    Gleason 3+4
    10 lymph nodes tested, all negative. Seminal vessels and bladder neck negative.
    Positive surgical margin
    Extraprostatic extension present
    Perineural invasion present

  6. #6
    Hi RAD! Sorry for the circumstances that brought you here but you have arrived with all of the worst parts of the "Journey to The Cure" behind you! Congrats!

    Jim215's response is both eloquent and to the point.

    Since you were on TRT for 15 years, did your MD(s) monitor your PSA regularly? What were your PSA results over the past 5 years? And what led to having a biopsy?

    We have had a few other Forum Brothers who had been on TRT and arrived here with PSAs in the high 100s. So consider yourself quite fortunate. I am guessing that your PSA was monitored regularly. Testosterone can act similar to "gasoline being tossed onto a small smoldering PC fire!" (this is a generalization. PC is a heterogenous disease and there are possibly some forms that are less sensitive to testosterone. Some have reported returning to TRT following RP - but this would require: Determination of complete cure, extreme Medical expertise and vigilant monitoring via uPSA)

    Glad your RP is now in the past. Your path report summary looks encouraging. Gleason downgrade is always good!

    Re "Positive Focal Margin Left Posterior:" Discuss this with your URO surgeon and the implications. Ask if you should monitor your PSA moving forward with an Ultrasensitive PSA Methodology (uPSA)

    If medically able, get on a regular exercise regimen and keep the workouts varied. At very least, get on a walking program. Exercise has wonderful effects on psyche, stamina and physical appearance.

    Good luck and best wishes for a < 0.01 ng/ml result later in May!

    Keep us updated.

    MF
    Last edited by Michael F; 03-24-2017 at 03:06 PM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  7. #7
    Top User
    Join Date
    Aug 2016
    Posts
    1,708
    Sorry for what is happening. My encouragement is with the rest, and to encourage you to have a treatment plan for your depression if you do not.
    Born 1953
    family w/PCa; grandfather, 3 brothers
    07-12-04 PSA 1.90
    07-10-06 PSA 2.02
    08-30-07 PSA 3.20
    12-01-11 PSA 5.69 Internist recommends urologist, I say no
    05-16-12 PSA 4.76 manipulate w/diet & supplements
    12-11-12 PSA 5.20, Health system changes to 3 years on testing
    03-07-16 PSA 7.20 Internist adamant on urologist
    DRE smooth, enlarged
    03-14-16 TRUS biopsy-prostatic adenocarcinoma 1%-60% across 8 of 12 samples, Gleason 3+3=6
    03-31-16 MRI pelvis w/o dye
    05-04-16 DaVinci prostatectomy, nerve sparing, Dr. Kent Adkins - recommend
    Final Path; weight 65g, lymph nodes, seminal vesicles, capsule, margin all negative, Gleason 3+4=7, Tumor volume 35%, +pT2c
    Catheter out - 16 days
    Incontinence at 6mos is minimal – no pad
    Cialis 3x/wk & Viagra on occasion
    Begin self-injection needle therapy for erections, stop after 6 due to onset of Peyronie’s
    Erections 100% - 14 months
    5-21-19 PSA <0.02, Zero Club 3.5 years

  8. #8
    Regular User
    Join Date
    Jan 2017
    Posts
    16
    Quote Originally Posted by Another View Post
    Sorry for what is happening. My encouragement is with the rest, and to encourage you to have a treatment plan for your depression if you do not.
    Thanks, my depression was before TRT was stopped and related to personal traumatic experience. I am under treatment and it is quite successful.

    An update....
    6 months post RP
    2 uPSA's now, both <0.006
    Implanted penile prosthesis 8/2/17
    Grateful and moving on with life (but am missing the testosterone)
    Age 65
    Dx Hypogonadism 15 years ago. Treated with Androgel. Discontinued upon Dx of PCa 1/2017.
    Testosterone now 50ng/DL. Not happy.
    Fusion Biopsy 1/3/17, 7 of 13 cores positive, highest Gleason 4+3 in two cores. Perineurial invasion present.
    Pre-op PSA 4.8
    Bone Scan Negative
    Robotic RP 3/1/2017. Px: pT2c NO Mx, Bilateral tumor 5-15% of prostate, Positive Focal Margin Left Posterior,
    Gleason downgrade to 3+4, Lymph nodes and Seminal vesicles negative, P
    Dx Major Depression 2015
    5/17/2017 PSA <0.006. Continence >98%. ED present, injections Bimix, Trimix ineffective.
    8/2/2017 Penile implant LGX
    8/25/2017 PSA<0.006

 

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