Is testosterone supplementation a potential risk for the prostate gland of an ageing male?

Czech version

Authors: doc. MUDr. Jozef Marenčák, Ph.D.
Authors‘ workplace: Urologické oddelenie NsP Skalica
Published in: Urol List 2007; 5(3): 46-53

Overview

The number of elderly people has been growing constantly in recent decades as a result of growing life expectancy. Androgen decline in elderly men is getting considerable medical attention. The Testosterone Deficiency Syndrome (TDS) is a clinical and biochemical syndrome which affects the functioning of different organs in the body and deteriorates the quality of life, primarily in elderly male patients. Possible pathophysiological mechanisms of age-related testosterone (TST) decline include: reduced hypothalamic GnRH outflow, impaired testicular steroidogenesis and altered sex-steroid negative feedback. However, there are still many issues in the pathophysiology of age-related TST decline which need clarification. New formulation s(oral, parenteral and transdermal) have been recently introduced in TDS therapy with success. TST supplementation is a safe and efficient method in hypogonadic men. The counter-indications of androgen replacement therapy (ART) are well defined and the risk is low. In spite of that, close monitoring of patients receiving the therapy is necessary, following generally accepted guidelines. The effect of TST replacement on the prostate gland is one of the most discussed and controversial aspects of andrology in recent times. Recent prospective studies have shown low incidence of prostate carcinoma (PC) linked with ARP. Androgen application is absolutely counter-indicated in men with diagnosed or suspected prostate carcinoma, as well as in men with suspected/detected breast cancer. ART cannot be indicated in men with abnormal digital rectal examination (DRE) results and/or with abnormal levels of the prostate specific antigen (PSA) in the serum. Histologically proven prostatic intraepithelial neoplasia (PIN) continues to be a point of controversy in relation to ART.

Conclusion:
There is still no scientific proof that TST is the cause of prostate carcinoma growth. The relationship between the sexual hormone and the prostate gland and its possible affection (benign prostatic hyperplasia, prostate carcinoma) has not yet been fully explained. Current knowledge in both experimental and human medicine concerning the safety of ART in hypogonadic men with TDS are discussed. Additional quality, long-term, randomised clinical studies involving a larger number of patients are necessary.

Key words:
testosterone replacement therapy, prostate gland, safety

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