Challenge Your Castrate Resistant Prostate Cancer Diagnosis

One of the most significant turning points in your overall prostate cancer prognosis is the moment that you learn that your cancer has become castrate resistant. 

Prostate cancer uses your body’s androgens, especially its testosterone to grow and spread.  The most common first line treatment for men with advanced prostate cancer is known as hormone therapy or ADT.  This treatment involves stopping your body from producing androgens (primarily testosterone) as well as blocking your cancer's hormone receptors being able to utilize the small amounts of androgens still being produced.  Simply put, ADT involves castrating you.

Castration can be accomplished either by a surgical procedure called an orchiectomy or the removal of your testicles or by the use of certain medications, or chemicals that halt the production of your androgens.

In most instances, these strategies will be efficient and will control the prostate cancer, but only for a limited period.  In the ordinary course of the disease there will come a time when ADT will no longer work; despite your being castrated the cancer will wake up and continue to grow.  This change, which is referred to as becoming castrate resistant, is signaled by a rising prostate specific antigen (PSA) score.

When this happens, you will need to add to your ADT treatment additional drug therapies.  However, sometimes this significant treatment change is effected even before there has been a confirmation that a man has become castrate resistant!  

If you believe that you are castrated, but your PSA climbs,  your first task is to question or challenge the validity of the diagnosis of castrate resistant prostate cancer. 

In this situation, your first step should be to confirm that the PSA number is correct.  To make this confirmation is simple, go and have another, confirmatory PSA test.

Your second step is to confirm that the hormone therapy is working, or has made you castrate.  To make this confirmation is also simple, have a testosterone test.  Testosterone, like PSA, is measured in your blood.  The test is simple, it is cheap, and it usually is covered by medical insurance. 

When you have your confirmatory PSA test also have a testosterone test performed with the same blood draw. 

To be considered castrate you want to have your testosterone reduced to a castrate level, or <20 ng/dl.  If you find that you are above this level, discuss with your doctor taking a different approach in your ADT treatment protocol that might bring your testosterone level below the castrate level of <20 ng/dl and then evaluate your PSA score and scans to determine if you are castrate resistant.

Cancer ABCs believes that you through out your ADT treatment like your PSA, you should have your testosterone levels measured on a regular basis to be sure that you become castrate and that you stay castrate.

Joel T. Nowak, MA, MSW wrote this Post.  Joel is the CEO/Executive Director of Cancer ABCs.  He is a Cancer Thriver diagnosed with five primary cancers - Thyroid, Metastatic Prostate, Renal, Melanoma, and Appendiceal Cancer a rare cancer.