Thursday, May 16, 2013

71 year old Man with Hx of Prostate Cancer I'm Currently Replacing His Testosterone

My dear patient who I see regularly for chronic medical conditions including diabetes and blood pressure monitoring presented with an elevated PSA (prostate-specific antigen) of 5.9 in February 2012. Family history of prostate cancer is negative. Voids 5-6 times a day and was getting up every hour a night to urinate for a couple of years prior. Variable stream. I referred him to a urologist for further evaluation. He was advised to do an in office trans-rectal ultrasound and biopsy of the prostate which he completed 3/14/2012. The biopsy showed extensive prostate cancer Gleason 3+3, clinical stage T2b with perineural invasion which did correspond to an abnormal digital rectal exam. His bone scan and CT scan was not suspicious for metastatic disease. Treatment options included active surveillance, however in light of his age his options may be more limited if he decided on more aggressive treatment in the future. Radical prostatectomy, cryosurgery, brachytherapy and or external radiation therapy or Calypso system hormonal therapy. My patient chose Brachytherapy which is a type of radiotherapy, or radiation treatment, offered to certain cancer patients. There are two types of brachytherapy – high dose-rate (HDR) and low dose-rate (LDR). LDR brachytherapy is the type that is most commonly used to treat prostate cancer; it may sometimes be referred to as ‘seed implantation’ or it may also be called ‘pinhole surgery’. In LDR brachytherapy, tiny radioactive particles the size of a grain of rice (see Figure 1) are implanted directly into the site of the tumour. These particles are known as ‘seeds’, and they can be inserted linked together as strands, or individually. Because the seeds are inserted or implanted directly into, or very close to, the tumour, they deliver high doses of radiation to the tumour without affecting the normal healthy tissues around it. This means that the procedure is less damaging than conventional radiation therapy, where the radioactive beam is delivered from outside the body and must pass through other tissues before reaching the tumour. He was told that he would need to reduce his testosterone levels before the implant to zero. The side effects were discussed with him and included, hot flashes, painful gynecomastia, erectile dysfunction, loss of libido, metabolic syndrome, anemia, bone loss, fatigue, depression, and weight gain to name a few. He was given Prosteon Oral tablets and told to take 2 tablets twice a day to replace calcium and vitamin D3 due to the side effects of the medication to reduce his testosterone to zero with a medication called Lupron. Now lets discuss his labs. In February 2011 his PSA was 3.7 and Testosterone 197 and his Vitamin D3 zero! His PSA in February 2012 was 5.9 and his testosterone was 213 In November 2012 (post hormone ablation procedure) his PSA was 0.3 and his Testosterone Zero and Vitamin D3 21.2. His symptoms were horrible in November 2012. At his office visit he told me he was experiencing horrible fatigue, depression, not sleeping, crying easily. He was scheduled to have the pellets inserted end of November 2012. He returned to see me in February 2013 and was regretting getting the surgery done because now he was experiencing urination about 10 times every night and he was not sleeping well, very fatigued, no appetite, getting hot flashes, dribbling and leaking and had to apply pressure to his bladder to urinate and was wearing diaper pants for leakage during the day. He was also having joint pain. He was taking antidepression medications, anti anxiety medications, diabetes and blood pressure medications and had just gotten a lupron injection by the urologist. We discussed his symptoms in great detail and that they were because of the Lupron injection and the zero testosterone level. I suggested a transdermal testosterone cream as well as Vitamin D3. He was willing to try it. He said to me that if he had a choice to live like this the rest of his life, he'd rather not. I understand!! Now this 71 year old man completely understood how menopausal women feel. It's horrible. Let's fast forward now to April 9, 2013, His PSA is 0.3, Testosterone is 1135, and Vitamin D3 is 58.1 He is feeling great. Sleeping again. No joint aches. No depression. Has his energy again. Has a scheduled trip with friends and family and feels amazing. He has had follow up exams with the urologist and his urologist is aware of the treatment plan my patient has chosen and is okay with it. I just saw him today and he is doing wonderful. He leaves Sunday for his trip and I know he will have an amazing time. Call my office in Lombard (630) 627-3700 to set up an appointment or email me at hormone replacement therapy, hormone imbalance, women to women, bodylogicmd, hormone replacement after hysterectomy, bioidentical hormones, HRT, women's health, men's health, TS Wiley, The Wiley Protocol


joe power said...

this was an interesting article , thanks for posting! i found it useful as i was looking for hormone replacement therapy in Phoenix AZ, thanks again!

Hilary Kimbel said...

Do you know if there is a place to go for hormone replacement therapy in Tampa? I just moved here, so I'm not sure where to look. But, I would really like to get more information and talk to a specialist!

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