In this article we will examine the role of testosterone supplementation in prostate cancer patients and in patients who do not have prostate cancer. In those who do not have prostate cancer, we will look at research to see if testosterone supplementation increases or does not increase risk of prostate cancer. It is important to understand that each man is an individual case and that the information presented here is a general information article. The use or non-use of testosterone supplementation in each case should be discussed with your health care providers.
We are going to look at recent research and bring it up to date. Let’s start with this 2014 study from the Baylor College of Medicine, (1) and a summary of this research:
“Hypogonadism is a common condition that affects older men and has detrimental effects on quality of life. Early studies of testosterone supplementation in patients with prostate cancer suggested that replacement of testosterone had profound implications on the progression and recurrence of prostate cancer due to an androgen-mediated stimulation of prostatic tissue. Recent data however, suggests that the correlation between elevated serum testosterone levels and prostate cancer progression might not be as direct as once perceived. Indeed, a recent study found no change in overall cancer risk, or prostate cancer risk for men over 40 on long-term testosterone supplementation.”
“. . . physicians should be comforted by the fact that there is currently no evidence that testosterone supplementation increases prostate cancer risk in otherwise healthy men. “
“. . . Men with low-risk prostate cancer on active surveillance can be safely given testosterone supplementation with an effective resolution of symptoms.”
“In men who have undergone some form of radiotherapy, the current consensus is that testosterone supplementation is safe and efficacious.”
“The results for these studies again echo what was previously found – that testosterone supplementation in low-risk disease does not appear to increase cancer recurrence rates or PSA while effectively raising serum testosterone and treating hypogonadal symptoms. However, in patients with high-risk disease, statistically significant increases in PSA after 18–24 months post testosterone supplementation cause concern. Since erratic PSA responses in a specific group of men on testosterone supplementation has been documented caution must be used and close monitoring employed.
“(Therefore) Proper patient selection is critical, and the diagnosis of hypogonadism should only be made given the presence of both low levels of serum testosterone and the presence of significant hypogonadal symptoms.
Risks of prostate cancer unfounded?
As noted in this research, in the past urologists warned that men taking testosterone replacement therapy were at higher risks for prostate cancer. In fact men suffering from prostate cancer are placed on hormone therapy that curtails the production of testosterone in their bodies.
In 2016 there were numerous research papers published questioning the risks of testosterone supplementation on prostate cancer. Here are some of the points of these studies.
In November 2016 a study (2) lead by European researchers and John Hopkins Medical School suggested that:
Prostate cancer appears to be unrelated to high testosterone levels. Testosterone Replacement Therapy for symptomatic hypogonadism (Low-T) does not appear to increase PSA levels nor the risk of prostate cancer development.
In October 2016, Urologists at Baylor College of Medicine found that:(3)
“Despite the historical reluctance toward the use of testosterone therapy in men with a history of prostate cancer, modern evidence suggests that testosterone replacement is a safe and effective treatment option for hypogonadal men with non-high-risk prostate cancer.”
Also in 2016 doctors from The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions wrote in the medical journal Aging Male:(4)
“testosterone replacement therapy did not affect serum PSA level, prostate volume and maximal urinary flow rate. This study also suggests that testosterone replacement therapy does not cause the risk for prostate cancer development”
In 2020 controversy and debate still exists
In the 4 years since, many research papers have come out in favor of testosterone supplementation in men with and without prostate cancer while other papers have stood by the older recommendations not to supplement. Let’s look at the most recent studies on using testosterone replacement therapy in men with prostate cancer.
Once again we have research from Baylor College of Medicine in an August 2020 (5) study that suggests:
“Clinicians prescribing testosterone should be aware of the current controversies associated with testosterone supplementation. The current literature does not suggest that there is a significant risk with testosterone supplementation and prostate cancer, worsening of Benign prostatic hyperplasia symptoms or cardiovascular events. However, more studies, including randomized placebo-controlled trials, are needed. Finally, patients should be counseled appropriately regarding the indications for testosterone supplementation and the benefits of lifestyle modification prior to initiating testosterone supplementation.”
In July 2020 a paper in The world journal of men’s health (6) also spoke about controversies and confusion in the use of testosterone supplementation in prostate cancer patients.
“Compared to testosterone-untreated patients, testosterone-treated patients may not have increased risks for disease progression in prostate cancer. However, the quality of currently available evidence is extremely poor. Testosterone may be harmful in men with advanced disease burden, in those with untreated prostate cancer undergoing active surveillance, and in those with successfully treated prostate cancer but having high-risk disease.”
In a June 2020 study in the journal: Prostate cancer and prostatic diseases,(7) doctors wrote:
“In this multi-ethnic national cohort, testosterone therapy did not increase the risks of biochemical recurrence or prostate cancer-specific or overall mortality after surgery or radiation. These data suggest that testosterone therapy is safe in appropriate men after definitive treatment of localized prostate cancer.”
As mentioned above, it is important to understand that each man is an individual case and that the information presented here is a general information article. The use or non-use of testosterone supplementation in each case should be discussed with your health care providers.
If you would like to explore more information, please contact our office so we can start a conversation with you.
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References
1 Kovac JR, Pan MM, Lipshultz LI, Lamb DJ. Current state of practice regarding testosterone supplementation therapy in men with prostate cancer. Steroids. 2014 Nov 1;89:27-32.
In the past urologists warned that men taking testosterone replacement therapy were at higher risks for prostate cancer. In fact men suffering from prostate cancer are placed on hormone therapy that curtails the production of testosterone in their bodies.
2: Boyle P, Koechlin A, Bota M, d’Onofrio A, Zaridze DG, Perrin P, Fitzpatrick J, Burnett AL, Boniol M. Endogenous and exogenous testosterone and the risk of prostate cancer and increased prostate-specific antigen (PSA) level: a meta-analysis. BJU Int. 2016 Nov;118(5):731-741.
3. Nguyen TM, Pastuszak AW. Testosterone therapy among prostate cancer survivors. Sexual medicine reviews. 2016 Oct 1;4(4):376-88.
4. Michaud JE, Billups KL, Partin AW. Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk. Therapeutic advances in urology. 2015 Dec;7(6):378-87.
5. Khera M. Controversies with Testosterone Therapy. The Canadian journal of urology. 2020 Aug;27(S3):20-3.
6 Kim M, Byun SS, Hong SK. Testosterone Replacement Therapy in Men with Untreated or Treated Prostate Cancer: Do We Have Enough Evidences? [published online ahead of print, 2020 Jun 25]. World J Mens Health. 2020;10.5534/wjmh.190158. doi:10.5534/wjmh.190158
7 Sarkar RR, Patel SH, Parsons JK, Deka R, Kumar A, Einck JP, Mundt AJ, Kader AK, Kane CJ, Riviere P, McKay R. Testosterone therapy does not increase the risks of prostate cancer recurrence or death after definitive treatment for localized disease. Prostate Cancer and Prostatic Diseases. 2020 Jun 8:1-7.
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