Testosterone Replacement Therapy For Metastatic #ProstateCancer | #MarkScholzMD #AlexScholz #PCRI

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07/07/23

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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