Two patients of mine recently asked me about the
Milwaukee Journal Sentinel article regarding testosterone (T) replacement with the headline, "UW tied to male hormone marketing: Testosterone prescriptions soar despite weak research, risks." Here's a link:
http://www.jsonline.com/features/health/52802117.html
One of them actually stopped it because he became very concerned about T after reading the article. One of them asked me if he should stop it.
So, I was asked to write about this as I do prescribe testosterone, and I want to help ease the potential fears created by this article. Because of the detail of the article and the rebuttal of many points, I thought I would break it into three parts so the important points are not missed. The other two posts will come in the next few days.
I will quote the article and then cite articles that counter the point:
“... concerns that it may increase the risk of prostate cancer…”
- "The relationship between total and free serum testosterone and the risk of prostate cancer and tumour aggressiveness."
Morote J. Ramirez C. Gomez E. Planas J. Raventos CX. de Torres IM. Catalan R.
BJU International. 104(4):486-9, 2009 Aug.
CONCLUSION: Prostate cancer risk and tumour aggressiveness are not related to serum levels of total and free testosterone, but hypogonadal patients do not have a greater risk of prostate cancer and tumour aggressiveness.
- "Pretreatment serum testosterone and androgen deprivation: effect on disease recurrence and overall survival in prostate cancer patients treated with brachytherapy."
Taira AV. Merrick GS. Galbreath RW. Butler WM. Wallner KE. Allen ZA. Lief JH. Adamovich E.
International Journal of Radiation Oncology, Biology, Physics. 74(4):1143-9, 2009 Jul 15.
CONCLUSION: Low pretreatment testosterone levels alone did not affect disease recurrence or overall survival. Patients with baseline low testosterone who also were treated with androgen deprivation therapy had a trend toward decreased overall survival.
- "Testosterone therapy in hypogonadal men and potential prostate cancer risk: a systematic review."
Shabsigh R, Crawford ED, Nehra A, Slawin KM
International Journal of Impotence Research. 21(1):9-23, 2009 Jan-Feb.
CONCLUSION: Of studies that met inclusion criteria, none demonstrated that testosterone therapy for hypogonadism increased prostate cancer risk or increased Gleason grade of cancer detected in treated vs. untreated men. Testosterone therapy did not have a consistent effect on prostate-specific antigen levels.
- "Testosterone Therapy in Men With Prostate Cancer: Scientific and Ethical Considerations"
Abraham Morgentaler
Journal of Urology 181 (3):972-79, 2009 Mar.
CONCLUSION: Although no controlled studies have been performed to date to document the safety of testosterone therapy in men with prostate cancer, the limited available evidence suggests that such treatment may not pose an undue risk of prostate cancer recurrence or progression.
Also there have been active research studies in supplementing men with low testosterone who had prostate cancer. If we really thought that T caused prostate cancer, we would never even consider this. These original research studies by some of the leading urologists in the country and the world were presented in the 2008 meeting of the Sexual Medicine Society of North America:
- "Testosterone therapy in men with untreated porstate cancer on active surveillance"
Morgentaler A, Bennet R, Mohamed O, Chan R, Khera M, LIpshults L
CONCLUSION: Testosterone therapy in 13 hypogonadal men with untreated prostate cancer for a mean of 12 months was not associated with an increase in PSA or substantial rate of grade progression on repaeat prostate needle biopsy. These pilot results suggest that testosterone therapy may be cautiously considered in men with low-risk untreated prostate cancer.
- "Testosterone replacement therapy following radical prostatectomy"
Khera M, Grober E, Najari B, Mohmed O, Colen J, Lamb, D, Lipshultz L
CONCLUSION: Testosterone replacement therapy (TRT) is effective in improving testosterone levels in hypogonadal men following radical prostatectomy (RP). In this cohort of hypoogonadal men on TRT after RP there was a significant rise in testosterone values with no significant rise in PSA following TRT.
- "Analysis of the PSA response after initiating testosterone supplementation (TS) in patients who have previously received management for their localized prostate cancer"
Davila H, Arison C, Hall M, Salup R, Lockhart J, Carrion R
CONCLUSION: TS by T injection or transdermal gel is effective in improving T level in men following RP and external beam radiation therapy. No significant differences were noted between these groups with regard to PSA levels after TS. This pilot study confirmed consistent efficacy and safety concerning the use of TS after prostate cancer therapy, regardless they type of cancer treatment.
These are just articles within the last year. The urologic community has shifted its thinking on the relationship of testosterone and prostate cancer. The newspaper article did not show or quote any scientific studies. I hope that these studies in our medical and scientific literature can allay some of the questions and fears with testosterone replacement and prostate cancer risk.