New German-U.S. paper below [1].
Somewhat off-topic, but I know that a lot of men still regard testosterone [T] as PCa "fuel". It's not surprising. I was born at the start of the Huggins era & I'm astonished that we are still living in it. Huggins basically got his Nobel Prize for discovering that castration could be used to treat PCa. Giving the impression that T is dangerous stuff. {Well, T is a pussycat compared to estradiol [E2] - women reading this, feel free to chime in. LOL}
However, young men with high-normal T do not get PCa. When men do get PCa, T levels are typically significantly lower (the decline begins in one's early 30's at a rate of 1-2% / year). Men with PCa who have the lowest T at diagnosis have the worst prognosis. And T deprivation is merely palliative - not a cure - & fails within 18 to 24 months for most men.
Thanks to Dr. Morgentaler, the attitude towards T is changing. Doctors have been wary of treating hypogonadism in older men, for fear of unmasing occult PCa. That fear seems unfounded - certainly on a group basis.
The new study followed 805 hypogonadal men for up to 12 years. 412 "underwent TTh {long-term testosterone therapy with testosterone undecanoate}, 393 patients served as controls"
"TTh led to substantial and sustained reduction of ED; improvement in erectile function was significant for each successive year until year 9. This was accompanied by improvements in cardiometabolic risk factors and urinary function throughout the 12-year follow-up period. Benefits of TTh were stronger for patients with moderate/severe ED than for patients with no/minor ED. Incidence of prostate cancer, major adverse cardiovascular events, and mortality were significantly lower in men on TTh compared with untreated men."
"Long-term TTh for up to 12 years alleviates ED, improves cardiometabolic risk factors, and reduces prostate cancer. Patients must stay on TTh consistently for a long time to achieve maximum benefits of TTh."
It's not the first study to show that PCa risk can be reduced by restoring T levels.
My attitude to T was formed years ago when I looked at studies of the androgen receptor [AR]. At diagnosis, the AR is rarely mutated, but is invariably so by the time that ADT fails. In contrast, estogen receptor [ER] changes occur quite early (before diagnosis), with growth-inhibting ERbeta disappearing & growth-promoting ER-alpha taking its place. But researchers seem not to be interested in the role of estradiol in PCa.
We have seen two PCa prevention trials that sought to protect men by lowering dihydrotestosterone [DHT] levels: (1) the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial & (2) the {Finasteride} Prostate Cancer Prevention Trial (PCPT). Too bad that there will never be funding for a PCa prevention trial based on T restoration.
-Patrick
[1] ncbi.nlm.nih.gov/pubmed/307...
Aging Male. 2019 Feb 20:1-12. doi: 10.1080/13685538.2019.1575354. [Epub ahead of print]
Long-term treatment with testosterone undecanoate injections in men with hypogonadism alleviates erectile dysfunction and reduces risk of major adverse cardiovascular events, prostate cancer, and mortality.
Saad F1, Caliber M2, Doros G3, Haider KS4, Haider A4.
Author information
1
a Medical Affairs Andrology , Bayer AG , Berlin , Germany.
2
b American Medical Writers Association , Ft Lauderdale , FL , USA.
3
c Department of Epidemiology and Statistics , Boston University School of Public Health , Boston , TX , USA.
4
d Private Urology Practice , Bremerhaven , Germany.
Abstract
OBJECTIVE:
The association between erectile dysfunction (ED), hypogonadism, cardiovascular disease, and type 2 diabetes is well documented, but long-term data are limited. The aim of this study is to investigate effects of long-term testosterone therapy (TTh) with testosterone undecanoate in men with hypogonadism and ED.
PATIENTS AND METHODS:
Observational, prospective registry of 805 hypogonadal men with different degrees of ED, evaluated by the International Index of Erectile Function - Erectile Function Domain. Four hundred and twelve patients underwent TTh, 393 patients served as controls, with an observation period up to 12 years.
RESULTS:
TTh led to substantial and sustained reduction of ED; improvement in erectile function was significant for each successive year until year 9. This was accompanied by improvements in cardiometabolic risk factors and urinary function throughout the 12-year follow-up period. Benefits of TTh were stronger for patients with moderate/severe ED than for patients with no/minor ED. Incidence of prostate cancer, major adverse cardiovascular events, and mortality were significantly lower in men on TTh compared with untreated men.
CONCLUSION:
Long-term TTh for up to 12 years alleviates ED, improves cardiometabolic risk factors, and reduces prostate cancer. Patients must stay on TTh consistently for a long time to achieve maximum benefits of TTh.
KEYWORDS:
Erectile dysfunction; cardiovascular disease; hypogonadism; prostate cancer; quality of life; testosterone therapy
PMID: 30782054 DOI: 10.1080/13685538.2019.1575354
