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The Use of Testosterone in Patients with Prostate Cancer

January 20, 2017

Among the controversies of testosterone therapy has been an implication with prostate cancer.  I have been in medicine long enough to see the pendulum swing. I was taught in medical school that you don’t give testosterone to men because it causes prostate cancer. Morgentaler has shown over the last 15 years, with very credible data, that men with suboptimal testosterone levels are seven times more likely to develop prostate cancer Destroying the Myth About Testosterone Replacement and Prostate Cancer. It turns out that testosterone is not necessarily the cause of prostate cancer Long-term testosterone therapy does not increase risk of prostate cancer and No Evidence of TRT Link to Prostate Cancer.  I have had three patients in the last five years who presented with biopsy proven prostate cancer. The patients all required testosterone optimization to treat the metabolic syndrome (which consists of high cholesterol, altered sugar metabolism, and obesity with too much fat in the android or belly distribution). This was started prior to any treatment for prostate cancer because of increased cardiovascular risk with any surgery. We judiciously started testosterone and monitored to keep levels in the physiologic ranges that the body recognizes as “optimal.” Subsequent biopsies on all have come back negative for cancer. The bottom line is there is no hard evidence that testosterone causes prostate cancer. With suboptimal testosterone levels the PSA receptors in the prostate gland are not filled. If the patient has prostate cancer or not, then the addition of testosterone filling these PSA receptors can cause this number to go up temporarily. This will then come down in a period of 60 to 90 days. Whether it actually stimulates the prostate cancer is the controversy. There are other benign reasons for a temporary, short-term, and self-limited increase in PSA. Infection is one, with PSA levels coming down following antibiotic therapy. An increase can also be seen after intercourse. By the way, increased ejaculation has been associated with decreased risk of prostate cancer. It is healthy to empty the prostate gland on a regular basis. Let me throw in another aspect—toxicity. The toilet paper you are using likely contains BPA. So repeated application of a toxin close to the prostate gland…Is Your Toilet Paper Secretly Destroying Your Prostate Health? It is important to look at various aspects for the overall picture. Keep in mind that we are dealing with a hormone orchestra. This includes growth hormone, thyroid hormone, cortisol or adrenal hormones, and sex hormones such as testosterone, estrogen, progesterone. With many diseases, the overall picture is really a balance between all of these rather than an absolute value of each individually. So the game is not over Testosterone Therapy in Patients with Treated and Untreated Prostate Cancer: Impact on Oncologic Outcomes. Balance between all hormones is the key. There may even be a place for progesterone treatment in patients with prostate cancer-but that is another story.

Posted in Blog by jbosiljevac

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