This article is part two. A common medical myth is that Testosterone is somehow causative of prostate cancer. This has been found to be completely incorrect, as we will see below. Rather than elevated Testosterone being associated with prostate cancer, it is LOWER levels that are associated with aggressive prostate cancer with poor outcome.
Indeed, lower testosterone has been found to be associated with increased all cause mortality in males in a number of studies. Higher levels within the normal range are associated with less risk for Prostate CA. Click Here for part ONE. PSA Screening for Prostate Cancer, the Failed Medical Experiment Increased Mortality from Androgen Blockade for Prostate Cancer. Although the hormonal responsiveness of prostate cancer is well established, it is generally accepted that TRT does not induce the development of prostate cancer.
The PSA should then be monitored semi-annually as long as the patient remains on TRT, in addition to having an annual digital rectal examination. Testosterone and Prostate Cancer: An Historical Perspective on a Modern Myth? Abraham Morgentaler To review the historical origins and current evidence for the belief that testosterone T causes prostate cancer pCA growth.
Remarkably, this latter conclusion was based on results from only one patient. Multiple subsequent reports revealed no pCA progression with T administration, and some men even experienced subjective improvement, such as resolution of bone pain. More recent data have shown no apparent increase in pCA rates in clinical trials of T supplementation in normal men or men at increased risk for pCA, no relationship of pCA risk with serum T levels in multiple longitudinal studies, and no reduced risk of pCA in men with low T.
The apparent paradox in which castration causes pCA to regress yet higher T fails to cause pCA to grow is resolved by a saturation model, in which maximal stimulation of pCA is reached at relatively low levels of T. This historical perspective reveals that there is not now—nor has there ever been—a scientific basis for the belief that T causes pCA to grow. Discarding this modern myth will allow exploration of alternative hypotheses regarding the relationship of T and pCA that may be clinically and scientifically rewarding.
It has long been believed that higher testosterone levels cause greater prostate cancer growth. However, review of the original literature and current data reveal that this once-plausible hypothesis has become a modern myth that interferes with critical assessment of the topic.
Journal of Andrology, Vol. Managing the Risks of Prostate Disease During Testosterone Replacement Therapy in Older Men: Recommendations for a Standardized Monitoring Plan.
Clomid for Men with Low Testosterone Part One by Jeffrey Dach MD
Because testosterone administration could potentially promote the growth of residual cancer, replacement therapy in this setting should only be considered after urological consultation and after a thorough discussion of the potential risks. If replacement therapy is provided to such men, PSA levels must be monitored more frequently.
Thus, on average, older men experience a greater increase in serum PSA concentrations than populations of predominantly younger men.
Normal Testosterone Levels in Men – Average Ranges by Age Chart
Thus, once established, androgen deprivation is moderately effective in reducing prostate volume. Therefore, we do not know whether testosterone replacement therapy will increase the need for invasive treatment of BPH. However, it is possible that in patients with pre-existing, severe symptoms of BPH, even small increases in prostate volume during testosterone administration may exacerbate obstructive symptoms.
In these men, testosterone should either not be administered or it should be administered with careful monitoring of their obstructive symptoms and only after their prostatic enlargement has been effectively treated urologically. J Steroid Biochem Mol Biol. Prostate cancer risk in testosterone-treated men.
Data from all published prospective studies on circulating level of total and free testosterone do not support the hypothesis that high levels of circulating androgens are associated with an increased risk of prostate cancer.
Indeed, high-grade prostate cancer has been associated with low plasma level of testosterone. A clinical implication of these results concerns androgen supplementation which has become easier to administer with the advent of transdermal preparations patch or gel that achieve physiological testosterone serum levels without supra physiological escape levels. Higher Testosterone and DHEA levels reduces risk of Aggressive prostate cancer. Circulating steroid hormones and the risk of prostate www.2015genelsecim.org G, Morris HA, MacInnis RJ, English DR, Epidemiologic studies have failed to support the hypothesis that circulating androgens are positively associated with prostate cancer risk and some recent studies have even suggested that high testosterone levels might be protective particularly against aggressive cancer.
High levels of testosterone and adrenal androgens are thus associated with reduced risk of aggressive prostate cancer but not with nonaggressive disease.
Morgentaler A, Rhoden EL. An increased risk of prostate cancer was associated with more severe reductions in testosterone. No significant differences between men with prostatic cancer and those with BPH were found for serum LH levels. After logistic regression analysis, none of the hormones showed a significant difference in predicting the risk of prostate cancer in patients undergoing prostate biopsy with suspicion of the disease.
No support was found for the theory that high levels of testosterone increase prostate cancer risk. Prostate-specific antigen changes and prostate cancer in hypogonadal men treated with testosterone replacement therapy.
All men had a normal baseline PSA level before TRT and had routine laboratory investigations, including measurements of body mass index BMIhaematocrit, lipid profile, and liver function tests LFTs.
Patients with a biopsy-confirmed or recent history of prostatitis before treatment were excluded. TRT was discontinued in men who developed prostate cancer. Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. Marks LS, Mazer NA, OBJECTIVE: To determine the effects of TRT on prostate tissue of aging men with low serum testosterone levels.
Treatment-related changes in prostate volume, serum prostate-specific antigen, voiding symptoms, and urinary flow were minor. Testosterone Given After Treatment for Prostate CA. Testosterone replacement for hypogonadism after treatment of early prostate cancer with brachytherapy.
The objective of this study was to assess the risk of biochemical failure with TRT after treatment of early prostate cancer with permanent transperineal brachytherapy with or without external beam therapy in patients with low serum levels of testosterone and clinical symptoms of hypogonadism.
No patients stopped TRT because of cancer recurrence or documented cancer progression. Testosterone replacement therapy after primary treatment for prostate cancer.
Agarwal PK, Oefelein MG. PURPOSE: A history of prostate cancer has been an absolute contraindication for testosterone supplementation. We studied a cohort of hypogonadal patients treated with radical retropubic prostatectomy RRP for organ confined prostate cancer to determine if testosterone replacement therapy TRT could be efficacious and administered safely without causing recurrent prostate tumor. MATERIALS AND METHODS: Ten hypogonadal patients previously treated with RRP for organ confined prostate cancer were identified.
They presented with low serum total testosterone TT and symptoms of hypogonadism after RRP. There was decrease in hot flashes and an increase in energy level.
In highly select patients after RRP TRT can be administered carefully and with benefit to hypogonadal patients with prostate cancer. Testo causes Minor PSA elevation, but no increased CA risk. Prostate-specific antigen changes in hypogonadal men treated with testosterone replacement. Gerstenbluth RE, Maniam PN, Corty EW, Seftel AD. We assessed the effect of this treatment on serum prostate-specific antigen PSA levels and risk of prostate cancer in hypogonadal men with erectile dysfunction.
In conclusion, testosterone replacement therapy in men with erectile dysfunction and hypogonadism is associated with a minor PSA elevationbut there does not appear to be a short-term increase in risk for the development of prostate cancer.
No Reason to Withhold Testosterone for Men with Treated Prostate CA. Curr Treat Options Oncol. Testosterone therapy for men at risk for or with history of prostate cancer.
For this reason, it has been considered taboo to offer testosterone replacement therapy TRT to any man with a prior history of PCa, even if all objective evidence suggests he has been cured. Thus, US Food and Drug Administration-mandated language in all testosterone package inserts states that testosterone is contraindicated in men with a history of, or suspected of having, PCa.
Although there is little modern experience with administration of testosterone in men with known history of PCa, there is a varied and extensive literature indicating that TRT does not pose any increased risk of PCa growth in men with or without prior treatment.
The growing number of PCa survivors who happen to be hypogonadal and request treatment has spurred a change in attitude toward this topic, with increasing numbers of physicians now offering TRT to men who appear cured of their disease.
Publications have now reported no prostate-specific antigen PSA recurrence with TRT in small numbers of men who had undetectable PSA values after radical prostatectomy. Although still controversial, there appears to be little reason to withhold TRT from men with favorable outcomes after definitive treatment for PCa.
Monitoring with PSA and digital rectal examination at regular intervals is recommended. Testosterone replacement therapy and prostate cancer. There are compelling data showing that testosterone replacement therapy TRT does not increase the risk of prostate cancer.
The literature four published studies concerning men treated with TRT after definitive therapy for prostate cancer reports only one biochemical recurrence. Based on these data, physicians cannot really justify withholding TRT from symptomatic patients after they have been successful treated for prostate cancer.
Urol Clin North Am. The role of testosterone replacement therapy following radical prostatectomy. Khera M et al. There are compelling data to suggest that testosterone replacement therapy TRT in normal and high-risk men does not increase the risk for prostate cancer. In the few studies of men treated with TRT after a radical prostatectomy, there have been no biochemical recurrences. Based on these data, it is difficult to justify withholding TRT following a radical prostatectomy. If we do not lower the testosterone levels of eugonadal men after a radical prostatectomy, how can we justify not replacing testosterone levels in hypogonadal men to make them eugonadal following a radical prostatectomy?
Case Report: Untreated Prostate CA, PSA declines after Testosterone Rx. Two years of testosterone therapy associated with decline in prostate-specific antigen in a man with untreated prostate cancer.
This case provides support for the notion that PCa growth may not be adversely affected by changes in serum T beyond the castrate or near-castrate range. Testosterone deficiency syndrome: treatment and cancer risk. Testosterone deficiency syndrome TDS can be linked to premature mortality and to a number of co-morbidities such as sexual disorders, diabetes, metabolic syndrome, ….
Testosterone deficiency occurs mainly in ageing men, at a time when prostate disease benign or malign start to emerge. New testosterone preparations via different route of administration appeared during the last decade allowing optimized treatment to these patients. One potential complication of this treatment is the increased risk of prostate and breast cancer.
Consequently, the guidelines from the agencies and the institutions, the recommendations of the scientific expert committees and the attitude of the clinicians to who, when and how to treat hypogonadal patients, is very conservative, not to say, highly restrictive. To date, as documented in many reviews on the subject, nothing has been found to support the evidence that restoring testosterone levels within normal range increases the incidence of prostate cancer.
In fact, the incidence of prostate cancer in primary or secondary testosterone treated hypogonadal men is lower than the incidence observed in the untreated eugonadal population. Furthermore, it has been advocated that, under a rigorous surveillance, patients cured of prostate cancer can be treated with testosterone supplementation with beneficial results. Also note that concerning an answer which appears as an electronically posted question, I am NOT creating a physician — patient relationship.
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We are making such material available in our efforts to advance understanding of issues of significance. Very good overview of the current studies, very helpful to me as a recent user of TRT and a slight increase is PSA score. Bioidentical Hormones Natural Thyroid. Skip to primary content Skip to secondary content Home. The Importance of BioIdentical Hormones. The Safety of Bioidentical Hormones.
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Articles with related interest:. PSA Screening for Prostate Cancer, the Failed Medical Experiment. Increased Mortality from Androgen Blockade for Prostate Cancer. Rising PSA during Testosterone Replacement TherapyJohn Gore, MD and Jacob Rajfer, MD Department of Urology, The David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA.
As this case clearly demonstrates, a rising PSA does not necessarily imply that an undetected prostate cancer is present. It is not surprising to see PSA changes in men receiving androgen therapy. Myth that Testosterone Causes Prostate Cancer. To review the historical origins and current evidence for the belief that testosterone T causes prostate cancer pCA growth.
Effect of Tesosterone on PSA level. SHALENDER BHASIN et al. Monitoring PSA Levels in Older Men Receiving Testosterone Replacement —. These data taken together suggest that the administration of replacement doses of testosterone in men with androgen deficiency can be expected to produce a modest increment in serum PSA levels. Application of the PSA Velocity Criterion to Prostate Monitoring During Testosterone Administration.
Effects of Testosterone Supplementation on Prostate Volume and Course of BPH. Lowering of serum testosterone concentrations by administration of a GnRH agonist, or blocking androgen effects by administration of an antiandrogen is associated with a reduction in prostate volume.
Cancer Epidemiol Biomarkers Prev. Circulating steroid hormones and the risk of prostate www.2015genelsecim.org G, Morris HA, MacInnis RJ, English DR. Epidemiologic studies have failed to support the hypothesis that circulating androgens are positively associated with prostate cancer risk and some recent studies have even suggested that high testosterone levels might be protective particularly against aggressive cancer. Prostate Cancer Associated with Lower Testosterone Levels. Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center.
No Testosterone related adverse effects on Prostate Tissue Determined by Biopsy. Marks LS, Mazer NA. OBJECTIVE: To determine the effects of TRT on prostate tissue of aging men with low serum testosterone levels. Harvard Medical School, Urology. Disclaimer click here: www.2015genelsecim.org. Link to this article: www.2015genelsecim.org. Click on Image to Buy on Amazon. Buy Book on Amazon. Like us on Facebook Google Plus Jeffrey Dach MD Page. Alliance for Natural Health. Stop the Thyroid Madness.
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