PCa Severity & Testosterone Replacement Therapy

[pjoshea13]

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

[Break60]

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

[pjoshea13]

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