PCa Severity & Testosterone Replacement Therapy

New study below.

My feeling over the past 12 years, is that testosterone [T] should be tested at diagnosis. If the level of T is <350 ng/dL, T patches should be prescribed, since those men seem to have a worse prognosis.

& now comes a Swedish study that seems to support that. Men on testosterone replacement therapy [TRT] "had more favorable-risk prostate cancer {35% increase} and a lower risk of aggressive prostate cancer {50% decrease}".

"The increase in favorable-risk prostate cancer was already observed within the first year of TRT (OR, 1.61 ...), whereas the lower risk of aggressive disease was observed after > 1 year of TRT (OR, 0.44 ...)"

-Patrick

ncbi.nlm.nih.gov/pubmed/284...

J Clin Oncol. 2017 May 1;35(13):1430-1436. doi: 10.1200/JCO.2016.69.5304. Epub 2017 Mar 13.

Testosterone Replacement Therapy and Risk of Favorable and Aggressive Prostate Cancer.

Loeb S1, Folkvaljon Y1, Damber JE1, Alukal J1, Lambe M1, Stattin P1.

Author information

1

Stacy Loeb and Joseph Alukal, New York University, New York, NY; Yasin Folkvaljon, Uppsala University Hospital; Pär Stattin, Uppsala University, Uppsala; Jan-Erik Damber, University of Gothenburg, Gothenburg; Mats Lambe, Karolinska Institutet, Stockholm; and Pär Stattin, Umeå University Hospital, Umeå, Sweden.

Abstract

Purpose The association between exposure to testosterone replacement therapy (TRT) and prostate cancer risk is controversial. The objective was to examine this association through nationwide, population-based registry data. Methods We performed a nested case-control study in the National Prostate Cancer Register of Sweden, which includes all 38,570 prostate cancer cases diagnosed from 2009 to 2012, and 192,838 age-matched men free of prostate cancer. Multivariable conditional logistic regression was used to examine associations between TRT and risk of prostate cancer (overall, favorable, and aggressive). Results Two hundred eighty-four patients with prostate cancer (1%) and 1,378 control cases (1%) filled prescriptions for TRT. In multivariable analysis, no association was found between TRT and overall prostate cancer risk (odds ratio [OR], 1.03; 95% CI, 0.90 to 1.17). However, patients who received TRT had more favorable-risk prostate cancer (OR, 1.35; 95% CI, 1.16 to 1.56) and a lower risk of aggressive prostate cancer (OR, 0.50; 95% CI, 0.37 to 0.67). The increase in favorable-risk prostate cancer was already observed within the first year of TRT (OR, 1.61; 95% CI, 1.10 to 2.34), whereas the lower risk of aggressive disease was observed after > 1 year of TRT (OR, 0.44; 95% CI, 0.32 to 0.61). After adjusting for previous biopsy findings as an indicator of diagnostic activity, TRT remained significantly associated with more favorable-risk prostate cancer and lower risk of aggressive prostate cancer. Conclusion The early increase in favorable-risk prostate cancer among patients who received TRT suggests a detection bias, whereas the decrease in risk of aggressive prostate cancer is a novel finding that warrants further investigation.

PMID: 28447913 DOI: 10.1200/JCO.2016.69.5304

4 Replies

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  • I was on TRT for ten years prior to Dx with Gleason 9 PCa. My T was around 750 at the time as I recall. I don't believe TRT caused high risk PCa but who knows.

    Bob

  • Patrick, I also was on T replacement since 1993---20+ years before DX. All of my Doctors, agree that T supplementation does not cause Pca. I have discussed the work of a Urologist, who's name is not on my tongue, from the 1990' thru 2005, when he retired. His personal studies indicate a Different Pathway. I will repeat, some things: When I changed Doctors over the years, they all wanted to know If l was low T, and would have me come off to see what my Nadir was---which was always about 290, and immediately re-upped my script. The last 7 years I was using a Nature Identical compounded product, compounded by my pharmacist who specialized it Hormone Replacement Compounding. It was as close to what my own body made as possible.

    But back to the Doctors study, that he charted, and kept impeccable records as if he was doing a Clinical Trial. Over about 8 years this entailed over 600 men. So I will cut to the chase. Every man who was Diagnosed as having low T, he asked to Biopsy them. Not all agreed to be invaded.

    But those that did, even with PSA's of 2, and 3, that agreed to be Biopsied---20% of all low T DX men with very low PSA's and no indication, of Prostate Problems, also using Digital exams, for analysis----SHOWED VIA THE BIOPSY TO HAVE PROSTATE CANCER.

    These men the 20 % of 600 with low T had Cancer. And in most cases , a Urologist, upon a digital and a PSA, would say see you next year. So this Urologist's, FIRST TEST performed on new patients was a T test, not a PSA. If Low T, he would ask the men to be biopsied.

    He cured 120 Prostate Cancers, by catching them so early, before a PSA, caused suspicion.

    So here comes the Theory/not mine but I agree with. That when a Man is Low T, and is given T replacement, the body only recognizes certain aspects of the Supplementation, such as muscle building, strength, bone density, improvements, better sex, BUT as no matter how Nature Identical, the supplement was the Body Considered itself to be in a State of Low T. And did not recognize the T relative to the PROSTATE.

    So more of the theory goes like this: Low T='s a strong possibility of developing prostate cancer. So one of the areas of research, not being addressed, is what causes low T. If we can figure this out, we may have a preventative method against Pca, at least 20%---Now the men who had low T and were not scientifically followed, those that refused a Biopsy, or whose biopsies were negative; did they in later life develop Pca? Dr. Zeligs, in Colorado, is a proponent of the early work, of this Doctor whose name is in my brain fog, this morning---and his book is somewhere in my Library. The Title I believe is LOW T, and Supplementation.

    So here comes the corundum: It makes absolute sense in my mind that those of us with Pca, were probably Low T, and may not have known it. I think Patrick and I know we were low T, before DX. So we can say for almost a certainty that adding T supplementation, did not cause Pca---but when the body is saturated with T supplementation, as in BAT, or plain massive doses of T, the T acts as a disrupting drug, against those of us with PSA's doubling quickly or those that are castrate resistant. That is the corundum; T supplementation before DX is of no benefit but after DX, it is. John Hopkins is doing the Biggest study, and the results so far favor T treatment at some point in the Pca journey.

    This is true for about 15-20 supplements. Those that can Kill or alter the life style of the Pca cell in a Petri Dish. Why when I was taking them along with T supplementation, they had no effect in stopping the disease, but after the disease took hold, they now begin to show promise of working. Pre DX, a supplement. Post DX, a Drug?

    If I was in Pca research, I would have a whole team spending whatever time and money to find the mechanism that causes Low T. I think we would start at the Pituitary, and the Thyroid, and then the Adrenals. Somewhere in our Endogenous system lies an answer, to a puzzle yet to be decoded.

    Nalakrats

  • Nala,

    As Patrick Walsh (Hopkins) reported almost 20 years ago, T goes up after surgery. So the cancer is somehow able to influence production.

    -Patrick

  • Well understood. I think it is like someone losing their sight, and having compensation with ones hearing. The Prostate is quite married to the endocrine System. And compensation somehow takes place., after removal. But it does not answer the question, of low T= Pca---for a certain large segment of the male population.

    Yet as we know when we flood the Body with T, we clog up the Androgen Receptors, thus causing death to certain pathologies---as I do not yet believe BAT works on all pathologies, equally. Some say it is like taking the Pca cells to a buffet, and having them eat their favorite food, and keep doing it until they die of overeating. A simple analysis---[Mine].

    Nalakrats

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