Testosterone therapy (used to treat symptoms of testosterone deficiency) may not worsen prostate cancer in selected men undergoing active surveillance for early-stage disease. These results were published in the Journal of Urology.
Symptoms of testosterone deficiency (low testosterone levels) include fatigue, decreased libido, and decreased sexual performance. Testosterone therapy can help to relieve these symptoms, but it’s generally not given to men with a history of prostate cancer because of concern that testosterone therapy may fuel prostate cancer growth. Other research, however, has raised the possibility that the maximal effect of testosterone on prostate cancer is reached at a fairly low level of testosterone, and that testosterone levels beyond this point do not further increase cancer growth.
To explore the effects of testosterone therapy on men with untreated prostate cancer, researchers evaluated 13 men who were undergoing active surveillance for early-stage prostate cancer. All of the men were receiving testosterone therapy for symptoms of testosterone deficiency. In order to detect changes in their prostate cancer, the men were monitored with prostate biopsies, prostate-specific antigen (PSA) tests, and measurement of prostate volume.
Study participants received testosterone therapy for a median of 2.5 years after their prostate cancer diagnosis.
- Testosterone therapy raised the average blood level of testosterone from 238 ng/ml to 664 ng/ml
- Testosterone therapy did not appear to affect PSA level or prostate volume.
- Two of the men had biopsy results that suggested that the cancer may be worsening (Gleason score increased from 6 to 7). Additional follow-up, however, did not confirm cancer progression.
Although this study is small, it raises the possibility that testosterone therapy may be safe for selected men with a history of prostate cancer. The researchers conclude “The longstanding prohibition against testosterone therapy in men with untreated or low risk prostate cancer or treated prostate cancer without evidence of metastatic or recurrent disease merits reevaluation.”
An accompanying editorial recommends caution, noting “Although this approach is feasible, it is experimental at this point and patients should be appropriately cautioned.”
Morgentaler A, Lipshultz LI, Bennett R, Sweeney M, Avila D, Khera M. Testosterone therapy in men with untreated prostate cancer. Journal of Urology. 2011;185:1256-1261.
Agarwal PK. Editorial comment. Journal of Urology. 2011;185:1261.
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