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First and foremost, there is no evidence, nor has there ever been, that testosterone relates to prostate cancer.  For many years it was suspected that there was a cause and effect between the two.  So much so that Urologists commonly stop testosterone replacement when a patient is diagnosed with prostate cancer, and further will chemically castrate a patient with medication to completely abolish a man’s natural testosterone for up to 2 years after prostate cancer treatment.  This causes significant reduction in the patient’s quality of life and ability to have the mental and physical fortitude to combat the cancer.  However, many studies over the last ten year, most notably conducted by Dr Mohit Khera at Baylor College of Medicine, have shown that not only does testosterone not contribute to prostate cancer, but that there is no increased risk in using testosterone in patients with prostate cancer.

“National trends in testosterone prescriptions for men with treated prostate cancer suggest that many men are treated with TTh after prostate cancer therapy with patterns of indications and monitoring consistent with the general population”. Link

“TTh should be offered to select hypogonadal patients who have a history of definitively treated prostate cancer. Available evidence suggests that administration of TTh for the treatment of testosterone deficiency appears to be safe in patients previously treated with definitive local therapy for prostate cancer”.  Link

Data shows no difference in incidence of prostate cancer, changes in PSA, or urinary symptom scores between men on TRT and men not receiving testosterone, supporting this change in attitude toward TRT.  For example, the RHYME study observed hypogonadal men receiving and not receiving TRT. Out of all participants, 55 underwent prostate biopsy for suspected prostate cancer. The proportion of positive biopsies was essentially identical in men with on TRT (37.5%) compares to those not on TRT (37%). This suggests testosterone has no influence on prostate cancer risk.  Furthermore, Dr. Khera believes there is no study to date showing that men receiving testosterone have a higher incidence of prostate cancer than those not receiving testosterone. Dr McClain and Dr Kielman concur with this assessment. Link

Prostate cancer is, however, the cancer of men.  All men over the age of 40, but younger than 72, should have their PSA checked at least yearly.  We at Regenerative and Sports Medicine review the PSA of every male patient with every lab review.  Patients with results suspicious for prostate abnormality are referred for further testing and often recommended to a Urologist.

 

Author Todd Kielman PA-C, DMSc, MPAS

As a sexual medicine and hormone specialist for over 10 years, Todd brings immense value to the Regenerative & Sports Medicine team.

More posts by Todd Kielman PA-C, DMSc, MPAS

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