Recovering Testosterone After Hormone Therapy for

Embark Clinical Trial: Improved Outcomes with Enzalutamide in Biochemically Recurrent Prostate Cancer: www.nejm.org/d...
Donate to PCRI: pcri.org/donate/
For more information, visit pcri.org
0:52 When is it right for a patient with a stable PSA to discontinue hormone therapy?
3:36 What are the upsides to discontinuing treatment and regaining testosterone?
4:43 How can a patient feel safe from recurrence after discontinuing hormone therapy?
8:03 How soon after promising treatment response should a treatment be discontinued?
9:42 How effective is treating a metastasis with spot radiation and forgoing hormone therapy?
10:52 At what PSA level would a patient be urged to go back on treatment?
11:26 Is testosterone replacement available to patients with stable PSA's following treatment?
13:21 How can patients navigate the decision to end treatment with their physician/caregiver?
14:19 Alex's conclusions
Don't know your stage? Take the quiz: visit www.prostatecan...
To learn more about prostate cancer, visit www.pcri.org
Sign up for our newsletter here to receive the latest updates on prostate cancer and the PCRI: pcri.org/join
Who we are:
The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better-individualized care. Feel free to explore our website at pcri.org or contact our free helpline with any questions that you have at pcri.org/helpline. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.

[@georgemason4083]

Male aged 78. Five years ago had a PSA of 10, Gleason 8, had 28 doses of radiation plus firmagon injections monthly. PSA dropped right down 0.04. Almost three years ago it went up to 5. My urologist suggested biopsy, small amount of cancer detected Gleason 8-9. Had a pet scan small amount spread to pelvic lymph node. Was put on Erleader and three monthly Eligard injections. PSA almost immediately dropped to 0.01, has been 0.1- 0.04 for two years now. Have all the usual side effects, sweating and loss of energy are the worst. After watching a previous video about intermittent treatment I stopped all medication six weeks ago. Big improvement in energy and general well being, sweating has decreased in intensity. Had a PSA test (privately) last week, reading 0.1. Going to carry on and monitor. As an aside not sure what the accuracy tolerance of a PSA measurement is, must be some variation.

[@michaelcorenzwit8118]

Your programs are very helpful. I am an 80 with PC. My gleason score was 8.3 and my PSA was 23. I have undergone 45 radiation treatments and am taking Orgovyx and Abiraterone for the next 24 months. The questions asked and the Drs responses have greatly increased my understanding of the process. Thank you.

[@rancancookcanoy9768]

Very informative. I have undergone hormone therapy and radiation. The side effects of the hormone therapy is horrible. The hotflashes and night sweats are unbearable. I’m not sleeping well as the night sweats wake me up and I have a hard time getting back to sleep. I’m hoping my testosterone level will come back so I can improve my quality of life. Thank you.

[@rosecolored2024]

My family doctor gave me gabapentin to take for the hot flashes and it works quite well. I take half a pill or slightly more than half a pill and I sleep all night. Slight drowsiness in the morning but it goes away. I take it at about 8:30 p.m. to 9:30 p.m.

[@christophergwala5531]

@@rosecolored2024 Thanks for sharing. Gabapentin might help? That's a big deal for me. Thank you

[@rogerembry4777]

Iv been on Lupron for 3 1/2 years, I’m going to talk to my doctor about taking a holiday and see what it does,

[@wayneredd6776]

The money is in the treatment pal treat treat treat

[@Feliciayioung]

Are you guys okay?

[@Vincent50]

Thank u so much for this video. Last year in the Spring season I found out my PSA was 3.65. It doubled in two years when I had my last PSA count of 1.65. As my PCP told me not to panic he scheduled me to see a urologist who took some tests and all seemed ok but the exam she felt a small nodule which led to an MRI then a Biopsy. I found out I had cancer. After researching watching many of your videos which helped me to make a decision and I chose ADT and radiation. In November I had a PSMA PET SCAN which thankfully showed no spread of cancer so early December 2023 I got my shot of Eligard and started radiation February 1st. My life is still normal and I’m doing everything I’ve been doing, working, exercising, still having a fun filled life. The main side effects is urinating so my Dr gave me prescription of flow max which is helping a lot and those damn hot flashes. They come and go during the day but definitely at night they’re ugly so I turn on my fan and go back to sleep. Im a sweater by nature anyway and it doesn’t take much to get me started so that along with the hot flashes is a double whammy but they don’t last too long so I’m able to carry on. I thank God there’s not much to complain about as I continue on with my life. I have 2 weeks and a half left for radiation so the big question is will all this have tackled this cancer. My Radiation Dr/oncologist told me he didn’t think it’s a good idea to come off of Eligard as he wants me to stay on it for two years. My next shot is in June. He really needs to see this video. At 68 I’m thankful I’m doing well thus far. Im keeping all of us men in prayer as we fight this ugly monster.

[@Feliciayioung]

Please are you okay?

[@jeffpheffer4778]

Thank you. I am as grateful I found your site as I was when i found Adam Pick’s site about aortic valve disease and replacement in 2011. right before i decided to have my valve replaced in 2011 I am 4 months post cyberknife. my psa is less than .05. ( results last week) my urologist ( who recommended surgery but humbly accepted my decision to get radiation) high fived me but still strongly advises me to stay on ADT for 4 months. i plan a 3 month holiday and follow up with another psa test in june which will be 6 months post cyberknife ( radiation). maybe get him to order another psma-pet. i really HATE this chemical castration ( no wood since week before first shot- seems like years but only months) but it’s better than dying from Cancer. that’s what i repeat. GOOD LUCK TO ALL OF US and thank you Dr and your beautiful assistant whose name i know but can’t recall cause im 70 and give me a break. i’m old!!!

[@falseye60]

Thank you, doctor. This video is very informative and scientifically explained.

[@jxgardner]

I have aggressive ( G 8-9 ) cancer throughout the gland but no metastasis.. I stopped ADT after 9 months, PSA 0.1 ( from 20+). I want my testosterone back ! Originally 800, down to 15. ADT is a balanced judgement call re quality of life !

[@billwestervelt2393]

Same as you but I lasted a year on Lupron. I will get my first Testosterone test in a few weeks.

[@raydecampos7327]

Always the best place for thoughtful and reliable information. Thank you…

[@patrickdrury1480]

OMG are these good videos. Thank you so much.

[@pwaveqrs1]

In yr 5. PSMA confirmed Mets in common iliac lymph nodes. Finished 18 months of Lupron July 2023. Hated it. Will never do ADT again. Testosterone was still only 19 in Dec 2023. Started the carnivore diet in Jan 2024. Now in Aug 2024, T is 551 and PSA remains undetectable. Much stronger now. Can do 20 pushups and 5 pull ups. I’m 64 and feel better than I did at 34.

[@bridudrum]

Please tell me what you’ve done to get through. I’m one year off ADT, which I had for 24 months. ADT has reduced me to a weak old man who cry’s for no reason,sweats all night etc. it’s rat poison.

[@pwaveqrs1]

@@bridudrum I started eating only meat and eggs and some cheese in January. No plants of any kind. (Except decaf coffee. lol) sounds hard. It’s way easier than Lupron. My T came back from 19 to 551 in 7 months. The hot flashes happen but aren’t strong enough to wake me up anymore. PCRI said it takes the amount of time you were treated to recover. I was on it for 18 months. This Dec. Will be my 18 months post last shot. I don’t cry anymore. Even for Hallmarks movies with my wife. Used to. I cried for 2 hours on a golf course watching the LIV Pros. Not anymore. Eat meat. No plants.

[@pwaveqrs1]

@@bridudrum kzbin.info/www/bejne/b5OwpKaeZ8uJgdksi=s2T-icm4tnBjIrvi

[@davegilbreath]

I would like to learn more about testosterone supplements, 1 year after 18 months of zoladex and 2 years after 55 radiation treatments. Gleason 9 aggressive spread to localized lymph node I'm really tired of no energy. Testosterone last blood work past February 1.03 Thank you for all the great information with your videos.

[@henrydufour9688]

Thank you for this vital information

[@bobliening5783]

Thank you for speaking to the subject of ‘holidays’. My oncologist doesn’t think it’s a good idea for me because I was Gleason 4+5=9 with an initial PSA of 1,300, and mets all up my spine and ribs, even though ADT brought my PSA down to 0.09 in about 3 months. Currently on my 25th month of ADT.

[@peterwells5424]

Excellent information. Very helpful for my current situation. This and your other videos have helped me so much! Really thank you!

[@KubotaManDan]

I'm doing this Lupron & Enzalutamide treatment for 6 months & the side effects, hot flashes is somewhat horrible. I'm 66 Gleason 7 and quality of life is pathetic. I'll ask my Dr. But he said I'd have to be on this treatment forever. My PSA is 0.02 and I was told the cancer is gone.

[@southernload5710]

Same here Gleason 8, my prostate was removed. During surgery Doctor noticed it had spread to my bladder. He recommended radiation and hormone therapy, xtandi & orgovyx. 3 months later my PSA 00.2. I've been on hormone therapy 12 months. My psa is undetectable. He wants to keep me on therapy 12 more months. That will be very difficult for my body. I may taper off on my on.

[@chrisvincent8123]

I would definitely try intermittent therapy. I have been doing so since 2012, after surgery and radiation in 2011-12. I was Gleason 7/8. 61yo in 2011.

[@Feliciayioung]

I hope you become better.❤

[@Feliciayioung]

@@chrisvincent8123how are you feeling?

[@paulrobinson2125]

18 months of hormone blocker studies show equivalent to 36 months. Life was awful for me on blocker and I stopped blocker after a year and been clear for last 3 years and worked hard to get back to where I was before treatment

[@yogarus1]

Would love a deep discussion of photon vs proton beam therapy.

[@wayneredd6776]

Extremely helpful!!

[@nickband2072]

As always very good and encouraging information

[@jackem8922]

Following on from my previous message, I just checked another PCRI video on the same topic, and it seems that this is the correct reference, specifically because of the following sentence: "Treatment was suspended at week 37 if the PSA level was less than 0.2 ng per milliliter and was restarted when the PSA level was at least 5.0 ng per milliliter (if the patient had not had previous radical prostatectomy) or at least 2.0 ng per milliliter (if the patient had previously had radical prostatectomy)". However, I know that if I showed this reference to my oncologist, he would be totally unimpressed, since intermittence is not the key topic of the paper. More relevant papers would appear to be on the 20-year old studies that Dr. Scholz mentions that compared patients who took ADT holidays with those who did not, for exactly the same 10-year outcome. Any chance that you could post those links?

[@kevinpalamar7621]

Thanks so much!!! Your video's are A++++

[@jackem8922]

Excellent video, but I believe that the link is incorrect. Instead of linking to a paper about intermittent hormone therapy, it links to a paper with the following title on an unrelated topic: "Improved Outcomes with Enzalutamide in Biochemically Recurrent Prostate Cancer". Please update the link to the correct paper.

[@frankmoen4666]

Dear Alex, can you please ask Dr. Scholz to explain prognosis and outcome of PCa patients wrt. BCR and overall survival when intraductal & cribriform type morphologies are in histology/Pathology reports. Should these finding upgrade the cancer and GS? Are these findings make the cancer more aggressive and increases the probability of spread and metasteser?

[@simmomantua8910]

Feel lucky I'm on Lupron and I don't have any side effects other than being a little more emotional G7 4+3

[@dennisxenos2790]

Thank you

[@MyronAnderson-r3t]

What outlook for a 64yr. Old Gleason 9 and HIV positive on blood pressure meds?

[@tnvol5331]

I thought prostate cancer became immune to ADT at around the 2 year mark. Am I wrong?

[@UPeri]

I’d like links to the 20 year old trials he mentioned. I only see the 2023 EMBARK trial listed.

[@zenman11]

what is the alternative effective, non toxic strategy he is talking about at 11.20. ??

[@vanman3752]

How does the clinical trial linked in your description 'Improved Outcomes with Enzalutamide in Biochemically Recurrent Prostate Cancer' relate to 'Intermittent Hormone Therapy?

[@russelmills9271]

What about the new drug SA53?

[@charlesmcgill8688]

Can Mark Scholz MD give his opinion on the use of superphysiological testosterone levels to experience BAT Binary Androgen Therapy? (as opposed to recovery to normal levels of testosterone). It was reported this can make Enzalutamide work again when it has stopped working.

[@julitoyranela7928]

I took relugolix for 6 months now 1 year after I feel hot on my upper body that last for hours is this normal? I thought I had a fever but nothing? Thank you very much

[@russelljohn5258]

10 yrs after prostatectomy and undetectable PSA it started to rise to 0.18. After PSMA pet scan negative and a year later PSA 0.41. 1 month Casodex then 9 months lupron along with prostate bed radiation 7 weeks treatment. Now 78 years old waiting for testosterone to recover but sill having hot flashes 5 months after my last 3 month lupron dose injection still having hot flashes and feeling tired and weak. I will ask my oncologist at next appt late April about testosterone patches to get some T back. My health has deteriorated significantly during ADT treatment, that is my biggest worry, bigger than my worry about prostate cancer return. If PSA rises again, will get another PSMA Pet scan and make decisions from there. Your thoughts?

[@wayneredd6776]

I was diagnosed at 60 years old. I had Glease at nine I had a PSA of only around 4 1/2. I did my homework and I was in tune with PCI. I decided to get one week of radiation. I was on hormone therapy for one year, I’ve been off of it now for about a year. My PSA is just about undetectable, but if it continues to go up I’m not gonna do anything. I’m not going back on hormone therapy. I can only imagine what it’s like for you at your age I would stop taking anything that you’re taking whether it’s oral if you’re going in for quarterly injections. Good luck buddy.

[@PaulKennedy-pr8tj]

Im currently on prostrap 3 after 20 doses radiotherapy my last injection is 27th march that will be 2 years on HDT my psa in beginning was 85.6 now 0.1 never had a bounce psa has always dropped every 3 months what can i expect regarding testesterone reproduction ect.. I am 60 and does this affect my testosterone reproduction ..

[@stevenjohnson9753]

He speaks of PSMA PET as something that doesn’t affect the body if used regularly. Is that true? The injection what I’ve read is it’s equal to 5 years of normal outdoor radiation. He doesn’t speak of individuals who have Kidney issues. Doing a PSMA PET scan every 45 or 90 days alarm bells go off in my head. Am I just being paranoid or delusional regarding these kind of scans on a regular basis?

[@landrover4124]

Medicare and those insurance cos. that pay for PSMA PET scans only allow those every 4 months ( 3 times per year).

[@n.c.b.8832]

Hi Steven, im in UK just wish I could get a PSMA scan, when I ask , the reply is not for you, if not then who ?? been on hormone treatment almost 2 years done a fantastic job PSA almost zero I am grateful for it, was told it was for life but this video along with others gives me hope, taking breaks from treatment allowing the body to naturally recover sound good to me. How can I get my Oncologist to watch this video ? Phil

[@MikeMcCown-m2z]

@@n.c.b.88320

[@jdotoz]

Technically any radiation exposure can have bad effects, but practically speaking it's a probability game. The decision to expose yourself to radiation always has to involve a comparison of the risk to the benefit. Each scan is far below the dosage threshold for acute radiation symptoms, so the risk is introducing chronic problems, primarily cancer. But you already have cancer in this case, so detecting the extent of the spread could be worth the risk.

[@Prog-t9d]

Mood swings, major brain fog, fatigue, anxiety, depression. Not another injection for me.

[@grizzlyrideemwet1698]

The linked "embark clinical trail" published in 2023 does not seem to be the study done in the 1990's referred to in the video. Gleason 9, PSA around 8.5 at diagnosis. Prostatectomy showed positive lymph nodes so radiation and ADT for 4 years. Oncologist would have defaulted to "rest of my life" but I elected to stop ADT about 2 years ago with the advent of PSMA/PET. My oncologist was willing to abide by my decision and continue monitoring my status. I believe there is some worry of liability if they bring it up, but it is a personal quality of life decision. Now 60, no recurrance on PSA, (

[@edg531]

Congrats! Everything you stated makes perfect sense. I hadn’t considered the liability issue, but you’re probably right. It’s good for us all to remember that in the end, the medical decisions are ours to make.