Phase III clinical trials have demonstrated the viability of intermittent hormone therapy in many patients with advanced prostate cancer -- this means that patients with undetectable PSAs who, in the past, would have been treated with hormone therapy for the rest of their lives can now consider allowing their testosterone to return, monitoring the PSA until it reaches a certain threshold, and then resuming hormone therapy at least until an undetectable PSA is again achieved. But what if a man's testosterone does not recover naturally?
In this video, PCRI's Alex and medical oncologist Mark Scholz, MD, discuss whether it is safe for a man on intermittent hormone therapy to use testosterone replacement if his testosterone does not return to eugonadal levels naturally.
Dr. Scholz also explains how the advent of the PSMA PET scan has made intermittent hormone therapy (combined with testosterone replacement therapy if the testosterone does not recover naturally) even more attractive because it offers an opportunity to see whether the lesions are treatable with spot radiation or some other treatment, which could delay or completely negate the need to resume hormone therapy.
Finally, they discuss "bipolar androgen therapy," which is a treatment for men with very advanced prostate cancer that has shown anti-cancer benefits in a certain percentage of men; however, its use is limited to some of the most advanced cases.
0:07 In which situations could a man with advanced prostate cancer consider testosterone replacement therapy?
3:26 If someone with advanced prostate cancer ends testosterone deprivation therapy and allows their testosterone to return (or initiates testosterone replacement therapy if it does not recover naturally) how soon do you expect their PSA to rise? Is there a safe or unsafe PSA velocity?
5:20 Can someone with extensive metastatic disease consider temporarily discontinuing testosterone deprivation therapy, or is it only a consideration for men with oligometastatic disease (fewer than five metastatic lesions).
7:51 How does age factor into whether a patient with advanced prostate cancer can temporarily discontinue hormone therapy?
8:32 How often should men on intermittent hormone therapy monitor their PSA and testosterone?
10:02 What are the risks and side effects of testosterone replacement therapy?
10:42 What is bipolar androgen therapy? Who is it for?
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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.
The information on the Prostate Cancer Research Institute's YouTube channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.
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