Is there a protective role of testosterone against high-grade prostate cancer?

New paper below.

"This study investigated the role of testosterone replacement therapy (TRT) in prostate safety and cancer progression. A cohort of 553 patients, 42 treated and 162 untreated hypogonadal men, and 349 eugonadal men were included."

"The incidence of positive prostate biopsies was lowest in hypogonadal men receiving TRT, with significantly lower severity of PCa in terms of staging and grading in the same group. These results suggest that TRT might have a protective effect against high-grade PCa."

Note that the aim of TRT has rarely been to restore high-normal testosterone [T] levels. Mostly, doctors aim for the lowest dose that gets T above 350 ng/dL.

My view is that estradiol [E2] needs to be monitored too. We need to avoid an estrogen-dominant E2:T ratio, IMO. & Arimidex, which inhibits T to E2 conversion should be considered.

-Patrick

ncbi.nlm.nih.gov/pubmed/282...

Aging Male. 2017 Mar 10:1-9. doi: 10.1080/13685538.2017.1298584. [Epub ahead of print]

Is there a protective role of testosterone against high-grade prostate cancer? Incidence and severity of prostate cancer in 553 patients who underwent prostate biopsy: a prospective data register.

Yassin A1,2,3, Salman M1, Talib RA4, Yassin DJ1,2.

Author information

Abstract

This study investigated the role of testosterone replacement therapy (TRT) in prostate safety and cancer progression. A cohort of 553 patients, 42 treated and 162 untreated hypogonadal men, and 349 eugonadal men were included. Pathological analysis of prostate biopsies examining the incidence and severity of PCa revealed that: 16.7% of treated hypogonadal men had a positive biopsy, a Gleason score of ≤6 in 71.4% and >6 in 28.6% of men, a predominant score of 3 and tumour staging of II in 85.7% men; 51.9% of untreated hypogonadal men had a positive biopsy, a Gleason score of ≤6 in 40.5% and >6 in 59.5% men, a predominant score of 3 (77.4%) and tumour staging of II (41.7%) or III (40.5%); 37.8% of eugonadal men had a positive biopsy, a Gleason score of ≤6 in 42.4% and >6 in 57.6% of men, a predominant score of 3 (82.6%) and tumour staging of II (44.7%) or III (47.7%). The incidence of positive prostate biopsies was lowest in hypogonadal men receiving TRT, with significantly lower severity of PCa in terms of staging and grading in the same group. These results suggest that TRT might have a protective effect against high-grade PCa.

KEYWORDS:

Gleason score; Hypogonadism; androgen receptor; prostate cancer; testosterone; tumor grading; tumor staging

PMID: 28282997 DOI: 10.1080/13685538.2017.1298584

4 Replies

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  • Yes, my understanding is the long term castration level Testosterone causes life threatening side effects on bones and circulatory system. (magnitude 6% increase danger for each month over six months exposure to castrate levels of T. Not sure how one does the calculation. Or if that holds for actual castration.) Since testosterone levels often do not recover after LHRH treatment stops, testosterone replacement seems important. You add the issue of the ratio between testosterone and estrogen. I assumed that since estrogen was derived in males from testosterone, that that ratio would stay in balance automatically. Guess not.

  • Wow. That seems to fly in the face of the conventional thinking -- that TRT for someone predisposed to prostate cancer is "like throwing gasoline on a fire". I heard that from my PCP who prescribed T cream. When it didn't improve my problem with fatigue I discontinued it after a month and a half, being very mindful of that cautionary statement. I was diagnosed with PC a year later.

  • The TRT studies all show that there is no increased risk for PCa. i.e. TRT does not act like gasoline at all.

    Men diagnosed with PCa tend to have lower T than matched controls. & the men with the lowest T tend to have the poorest prognosis.

    But the fact that castration has been a treatment for PCa since before I was born, convinces many that T must be the cause. Whereas T, although necessary for PCa growth, is not the driver. With low T, T becomes growth-permissive. At higher levels it assumes its traditional regulatory role.

    To the "gasoline" believers, I'd say: but ultimately, castration is not a cure for PCa.

    -Patrick

  • Leibowitz successfully treats many cases of PC with very high doses of T.

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