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


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


Sources

1. Morales A. The andropause: bare facts for urologists. BJU Int 2003; 91(4): 311-313.

2. Breza J, Novotný V, Bujdák P. Syndróm starnúceho muža. Sexuológia 2002; 2(1): 20-24.

3. Morales A, Heaton J, Carson C. Andropause: a misnomer for a true clinical entity. J Urol 2000; 163(4): 705-712.

4. Morales, A. , Schulman, C. , Tostain, J. et al. : Testosterone deficiency syndrome (TDS) needs to be named appropriately - the importance of accurate terminology. Eur. Urol. , 50, 2006; (2): 407-409.

5. Morales A, Lunenfeld B. Investigation, treatment and monitoring of late onset hypogonadism in males. Aging Male 2002; 5(5): 74.

6. Krause W. Die endokrine Basis von sexuellen Funktions - storungen im Alter. Urologe A 2000; 39(5): 411-413.

7. Ludwig G. PADAM aus urologischer Sicht. Urologe A 2000; 39(5): 407-410.

8. Morales A, Buvat J, Gooren L et al. Endocrine aspects of men sexual dysfunction. In: Lue T. Sexual Medicine - sexual dysfunctions in men and women. Paris: Health Publication 2005: 345-382.

9. Harman S, Metter E, Tobin J et al. Baltimore longitudinal study of aging. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab 2001; 86(4): 724.

10. Feldman H, Longcope C, Derby C et al. Age trends in the levels of serum testosterone and other hormone in middle age men: longitudinal results of the Massachusetts Male Aging Study. J Clin Endocrinol Metab 2002; 87(4): 589.

11. Morley J, Kaiser F, Perry H et al. Longitudinal changes in testosterone, luteinizing hormone and follicle stimulating hormone in healthy older men. Metabolism 1997; 46(5): 410.

12. Marenčák J. Andropauza. Súčas Klin Prax 2006; 3(suppl 1): 4-14.

13. Schulman C. Androgen replacement therapy in men at risk for prostate disease. 6th International Consultation on new developments in prostate cancer and prostate disease, June 24-27 2005, Paris, France.

14. Nieschlag E, Behre H, Bouchard P et al. Testosterone replacement therapy: current trends and future. Hum Reprod Update 2004; 10(5): 409-419.

15. Marenčák J. Syndróm starnúceho muža. Lekár List 2002; 7(28): 5-6.

16. Marenčák J, Moro R, Maskalyk M. Diagnostika a liečba mužov v andropauze. Urológia 2003; 9(4): 20-26.

17. Schulman C, Horie S, Kaufman J et al. Androgen therapy in men at risk for prostate disease. In: Mc Connell J , Denis L, Akaza H et al. Prostate cancer. 21. ed. Paris: Health Publication 2006: 348-362.

18. Behre H, Nieschlag E. Testosteronsubstitution beim alternden Mann. Urologe A 2000; 39(5): 421-424.

19. Behre H, Bohmeyer J, Nieschlag E. Prostate volume in testosterone - treated and untreated hypogonadal men in comparison to age - matched normal controls. Clin Endocrinol 1994; 40(3): 341-349.

20. Tenover J. Effects of testosterone supplementation in the aging male. J Clin Endocrin Metab 1992; 75(3): 1092-1098.

21. Sih R, Morley J, Kaiser F et al. Testosterone replacement in older hypogonadal men: a 12-months randomised controlled trial. J Clin Endocrin Metab 1997; 82(4): 1661-1667.

22. Bhasin S, Storer T, Berman N et al. The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Eng J Med 1996; 335(1): 1-7.

23. Huggins C, Stevens R, Hodges C et al. The effects of castration on advanced carcinoma of the prostate gland. Arch Surg 1941; 43(2): 209.

24. Tubaro A. Testosterone and prostate cancer. Eur Urol 2007; 51(2): 293-295.

25. Morales A. Testosterone and prostate health: de­bun­king myths demandes evidence, caution, and good clinical judgement. Eur Urol 2006; 50(5): 895-897.

26. Gould D, Kirby R. Testosterone replacement therapy for late onset hypogonadism: what is the risk of inducing prostate cancer? Prostate cancer and prostatic diseases advance online publication, 1. November 2005. doi: 10.1038/sj.pcan.4500839

27. Gann P, Hennekens CH, Ma J et al. Prospective study of sex hormone levels and risk of prostate cancer. J Natl Cancer Inst 1996; 88(4): 1118-1126.

28. Chen L, Stacewicz - Sapuntzakis M, Duncan C et al. Oxidative DNA damage in prostate cancer patients consuming tomato sauce - based entrees as a whole - food intervention. J Natl. Cancer Inst 2001; 93(6): 1872-1879.

29. Clark L, Combs G, Turnbull B et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin: a randomised controlled trial. JAMA 1996; 276(7): 1957-1963.

30. De Marzo A, Marchi V, Epstein J et al. Proliferative inflammatory atrophy of the prostate: implications for prostatic carcinogenesis. Am J Pathol 1999; 155(8): 1985-1992.

31. Jiang F, Wang Z. Identification of androgen - responsive genes in the rat ventral prostate by complementary deoxyribonucleic acid subtraction and microarray. Endocrinology 2003; 144(7): 1257-1265.

32. Henhgst L, Reed S. Translation control of p27 accumulation during the cell cycle. Science 1996; 271(8): 1861-1864.

33. Rhoden E, Morgentaler A. Risks of testosterone - replacement therapy and recommendations for monitoring. N Eng J Med 2004; 350(2): 482-492.

34. Hsing A. Hormones and prostate cancer: what´s next? Epidemiol Rev 2001; 23(1): 42-58.

35. Rhoden E, Morgentaler A. Testosterone replacement therapy in hypogonadal mena t high risk for prostate cancer: results of 1 year of treatmnet in men with prostatic intraepithelial neoplasia. J Urol 2003; 170(8): 2348-2351.

36. Shaneyfelt T, Husein R, Bubley G et al. Hormonal predictors of prostate cancer: a meta analysis. J Clin Oncol 2000; 18(5): 847-853.

37. Morgentaler A. Testosterone and prostate cancer: an historical perspective on a modern myth. Eur Urol 2006; 50(3): 935-939.

38. Tomera K, Gleason D, Gittelman M et al. The gonadotropin - releasing hormone antagonist Abarelix depot versus luteinizing hormone releasing hormone agonists leuprolide or goserelin: initial results of endocrinological and biochemical efficacies in patients with prostate cancer. J Urol 2001; 16(7): 1585-1589.

39. Freeland S, Partin A. Prostate - specific antigen: update 2006. Urology 2006; 67(2): 458-460.

40. Yano M, Imamoto T, Suzuki H et al. The clinical potential of pretreatment serum testosterone level to improve the efficiency of prostate cancer screening. Eur Urol 2007; 51(1): 375-380.

41. Morgentaler A, Brunning C, De Wolf W. Incidence of occult prostate cancer among men with low total or free serum testosterone. JAMA 1996; 276(8): 1904-1906.

42. Thompson I, Pauler D, Goodman P et al. Prevalence of prostate cancer among men with prostate-specific antigen level ? ng per milliliter. N Eng J Med 2004; 350(8): 2239-2246.

43. Ribeiro M, Ruff P, Falkson G. Low serum testosterone and a younger age predict for a poor outcome in metastatic prostate cancer. Am J Clin Oncol 1997; 20(8): 605-608.

44. Hoffman M, DeWolf W, Morgentaler A. Is low serum free testosterone a marker for high grade prostate cancer? J Urol 2000; 163(7): 824-827.

45. Teloken C, De Ros C, Caraver F et al. Low testosterone levels are associated with positive surgical margins in radical retropubic prostatectomy: hypogonadism represents bad prognosis in prostate cancer. J Urol 2005; 174(9): 2178-2180.

46. Nieschlag E, Gromoll J, Zitzmann M. Clinical relevance of androgen receptor pylomorphism. Eur Andr 2007; 1(suppl 1): 36.

47. Beharka R. Aging male, hormonal and genetic alterations. Eur Andr 2007; 1(suppl 1): 28.

48. Heráček J, Hampl R, Hill M et al. Tissue and serum levels of principal androgens in benign prostatic hyperplasia and prostate cancer. Eur Andr 2007; 1(suppl 1): 58.

49. Morales A. Endocrine aspects of men and women sexual dysfunctions including hormonal treatment. 2nd International Consultation on Erectile and Sexual Dysfunctions, June 28-July 1 2003, Paris, France.

50. Nieschlag E, Swerdloff R, Behre H et al. Investigation, treatment and monitoring of late - onset hypogonadism in males. Guidelines of European Association of Urology 2007. Arnhem 2007: 1-4.

51. Morales A, Buvat J, Gooren L et al. Endocrine aspects of sexual dysfunction. J Sex Med 2004; 1(1): 69-81.

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