RELATIONSHIPS OF TESTOSTERONE AND PROSTATE CANCER

Czech version

Authors: K. Chiles ¹; S. Honig ²
Authors‘ workplace: Resident in UrologyUniversity of CT Health Science Center ¹; Associate Clinical Professor of Surgery/Urology, University of CT Health Science Center Farmington CT ²
Published in: Urol List 2012; 10(1): 13-18

Overview

An understanding of the detrimental effects of hypogonadism is becoming more greatly appreciated and as a result testosterone replacement therapy (TRT) is becoming more common. Giving TRT to men who have a history of prostate cancer, however, is still quite controversial. This article reviews the literature regarding the evidence supporting and refuting a role of androgens and TRT in the pathophysiology of prostate cancer. The limited data of hypogonadal, prostate cancer patients treated with surgery or radiation is analyzed. In addition, an outline of the indications for and contraindications to TRT is provided with an algorithm of patient evaluation before and after TRT initiation.

Key words:
prostate cancer, hypogonadism, testosterone replacement therapy

Adapted from article originally published in Renal and Urology News.

Sources

1. Mulligan T, Frick MF, Zuraw QC et al. Prevalence of hypogonadizm in males aged at least 45 years: the HIM study. Int J Clin Pract 2006; 60(7): 762–769.

2. Warren MF, Serby MJ, Roane DM. The effects of testosterone on cognition in elderly men: a review. CNS Spect 2008; 13(10): 887–897.

3. Bassil N, Morley JE. Late-life onset hypogonadizm: a review. Clin Geriatr Med 2010; 26(2): 197–222.

4. Traish AM, Guay A, Feeley R et al. The dark side of testosterone deficiency: I. Metabolic Syndrome and erectile dysfunction. J Androl 2009; 30(1): 10–22.

5. Traish AM, Saad F, Guay A. The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance. J Androl 2009; 30(1): 23–32.

6. Traish AM, Saad F, Feeley RJ et al. The dark side of testosterone deficiency: III. Cardiovascular disease. J Androl 2009; 30(5): 477–494.

7. Huggins C, Hodges CV. Studies on prostatic cancer: I. The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. Cancer Res 1941; 1: 293–197.

8. Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol 2009; 55(2): 310–321.

9. Wang C, Nieschlag E, Swerdloff R et al. Investigation, treatment and monitoring of late onset hypogonidsm in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur Urol 2009; 55(1): 121–130.

10. Rhoden EL, Morgentaler A. Testosterone replacement therapy in hypogonadal men at high risk for prostate cancer: results of 1 year of treatment in men with prostatic intraepithelial neoplasia. J Urol 2003; 170 (6 pt 1): 2348–2351.

11. Lefkowitz GK, Taneja SS, Brown J et al. Followup interval prostate biopsy 3 years after diagnosis of high grade prostatic intraepithelial neoplasia is associated with high likelihood of prostate cancer, independent of change in prostate specific antigen levels. J Urol 2002; 168 (4 pt 1): 1415–1418.

12. Coward RM, Simhan J, Carson CC. Prostate-specific antigen changes and prostate cancer in hypogonadal men treated with testosterone replacement therapy. BJU Int 2009; 103(9): 1179–1183.

13. Shabsigh R, Crawford ED, Nehra A et al. Testosterone therapy in hypogonadal men and potential prostate cancer risk: a systematic review. Int J Impot Res 2009; 21(1): 9–23.

14. Marks LS, Hess DL, Dorey FJ et al. Prostatic tissue testosterone and dihydrotestosterone in African-American and white men. Urology 2006; 68(2): 337–341.

15. Mearini L, Zucchi A, Nunzi E et al. Low serum testosterone levels are predictive of prostate cancer. World J Urol 2011. (Epub ahead of print).

16. Hoffman MA, DeWolf WC, Morgentaler A. Is low serum free testosterone a marker for high grade prostate cancer? J Urol 2000; 163(3): 824–827.

17. Chodak GW, Vogelzang NJ, Caplan RJ et al. Independent prognostic factors in patients with metastatic (stage D2) prostate cancer. The Zoladex Study Group. JAMA 1991; 265(5): 618–621.

18. Massengill JC, Sun L, Moul JW et al. Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy. J Urol 2003; 169(5): 1670–1675.

19. Isom-Batz G, Bianco FJ Jr., Kattan MW et al. Testosterone as a predictor of pathological stage in clinically localized prostate cancer. J Urol 2005; 173(6): 1935–1937.

20. Schatzl G, Madersbacher S, Thurridl T et al. High-grade prostate cancer is associated with low serum testosterone levels. Prostate 2001; 47(1): 52–58.

21. Thompson IM, Goodman PJ, Tangen CM et al. The influence of finasteride on the development of prostate cancer. NEJM 2003; 349(3): 215–224.

22. Andriole GL, Bostwick DG, Brawley OW et al. Effect of dutasteride on the risk of prostate cancer. NEJM 2010; 362(13): 1192–1202.

23. McConnell JD, Wilson JD, George FW et al. Finasteride, an inhibitor of 5alpha-reductase, suppresses prostatic dihydrotestosterone in men with benign prostatic hyperplasia. J Clin Endocrinol Metab 1992; 74(3): 505–508.

24. Andriole GL, Humphrey P, Ray P et al. Effect of the dual 5alpha-reductase inhibitor dutasteride on markers of tumor regression in prostate cancer. J Urol 2004; 172(3): 915–919.

25. Joly-Pharaboz MO, Soave MC, Nicolas B et al. Androgens inhibit the proliferation of a variant of the human prostate cancer cell line LNCaP. J Ster Biochem Mol Biol 1995; 55(1): 67–76.

26. Umekita Y, Hiipakka RA, Kokontis JM et al. Human prostate tumor growth in athymic mice: inhibition by androgens and stimulation by finasteride. Proc Natl Acad Sci 1996; 93(21): 11802–11807.

27. Morris MJ, Huang D, Kelly WK et al. Phase 1 trial of high-dose exogenous testosterone in patients with castration-resistant metastatic prostate cancer. Eur Urol 2009; 56(2): 237–244.

28. Gann PH, Hennekens CH, Ma J et al. Prospective study of sex hormone levels and risk of prostate cancer. J Natl Cancer Inst 1996; 88(16): 1118–1126.

29. Pierorazio PM, Ferrucci L, Kettermann A et al. Serum testosterone is associated with aggressive prostate cancer in older men: results from the Baltimore Longitudinal Study of Aging. BJU Int 2010; 105(6): 824–829.

30. Koo JM, Shim BS. Significance of serum testosterone prostate-specific antigen (PSA) elevation and prediction of prostate cancer in patients with psa above 10ng/ml. Korean J Urol 2010; 51(12): 831–835.

31. Kaufman JM, Graydon RJ. Androgen replacement after curative radical prostatectomy for prostate cancer in hypogonadal men. J Urol 2004; 172(3): 920–922.

32. Agarwal PK, Oefelein MG. Testosterone replacement therapy after primary treatment for prostate cancer. J Urol 2005; 173(2): 533–536.

33. Khera M, Grober ED, Najari B et al. Testosterone replacement therapy following radical prostatectomy. J Sex Med 2009; 6(4): 1165–1170.

34. Sathyamoorthi K, Stein M, Mohammed O et al. Testosterone replacement therapy in high risk patients following radical prostatectomy. J Urol 2010 (Suppl).

35. Sarosdy MF. Testosterone replacement for hypogonadizm after treatment of early prostate cancer with brachytherapy. Cancer 2007; 109(3): 536–541.

36. Morales A, Black AM, Emerson LE. Testosterone administration to men with testosterone deficiency syndrome after external beam radiotherapy for localized prostate cancer: preliminary observations. BJU Int. 2009; 103(1): 62–64.

37. Morgentaler A, Lipshultz LI, Bennett R et al. Testosterone therapy in men with untreated prostate cancer. J Urol 2011; 185(4): 1256–1261.

38. Bhasin S, Cunningham GR, Hayes FJ et al. Testosterone therapy in adult men with androgen deficiency syndromes: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2010; 95(6): 2536–2559.

39. Rhoden EL, Morgentaler A. Risks of testosterone--replacement therapy and recommendations for monitoring. NEJM 2004; 350(5): 482–492.

40. Rhoden EL, Morgentaler A. Influence of demographic factors and biochemical characteristics on the prostate-specific antigen (PSA) response to testosterone replacement therapy. Int J Impot Res 2006; 18(2): 201–205.

41. Cooper CS, Perry PJ, Sparks AE et al. Effect of exogenous testosterone on prostate volume, serum and semen prostate specific antigen levels in healthy young men. J Urol 1998; 159(2): 441–443.

42. Behre HM, 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.

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Article was published in

Urological Journal

2012 Issue 1