In April 2022, my prostate was removed in a radical prostatectomy. My PSA dropped from 60 to 0.5. I was relieved. I was convinced the surgery had been successful at eradicating my prostate cancer. A few weeks later, my PSA had risen to 5.6; the cancer was back.
The cancer was now systemic, and a new approach was needed. In July 2022, I began the hormone treatment, ADT. I was injected with drugs to reduce my testosterone to zero; prostate cancer cells need testosterone to grow. ADT was likely a treatment I would need for the rest of my life.
But what did it mean to have zero testosterone?
The catabolic effects of androgen-deprivation therapy result in considerable unfavourable side effects, including loss of lean muscle mass, increased fat mass, reduced muscle strength, and lower bone mineral density, which places men at greater risk for functional decline and frailty. The good news is that the wasting effects of ADT can be offset by adopting a plant-based diet and adhering to a high-intensity resistance and aerobic exercise programme.(Focht et al., 2018)
From a psychological perspective, testosterone plays a complex role in human behaviour. Testosterone makes us more motivated to do what it takes to achieve and sustain social status. (Sapolsky, 2017, p. 310) Testosterone drives the risky behaviours we often see in young men. It drives us to achieve status in our social rankings; the best golfer, lecturer, and boxer, to be at the head of the queue in our chosen fields. Testosterone can lead to irrational behaviour but introduces species-enhancing attainment levels, with high risks for some individuals.
I can adapt to a testosterone-free life by doing what I should already be doing, having a good diet and a strenuous exercise regime. It also frees me from the irrational stress associated with the perceived need to achieve social status.
I can live with that.
ADT Androgen-Deprivation Therapy
PSA Prostate Specific Antigen
Focht, B.C. et al. (2018) ‘Effects of a Group-Mediated Exercise and Dietary Intervention in the Treatment of Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: Results From the IDEA-P Trial’, Annals of Behavioral Medicine, 52(5), pp. 412–428. Available at: https://doi.org/10.1093/abm/kax002.
Sapolsky, R.M. (2017) Behave: The biology of humans at our best and worst. Penguin.
Further information on PC