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• W43074641 abstract "AbstractTestosterone (T) deficiency, also termed hypogonadism, affects a substantial proportion of older men, and causes a variety of symptoms and signs, such as erectile dysfunction, diminished libido, fatigue, depression, and diminished bone mineral density. Testosterone replacement therapy (TRT) can be an effective therapy, but there has been a long-standing and widely held fear of offering TRT in the prostate cancer (PCa) patient due to the concern that higher T levels may “awaken” dormant PCa cells, and cause a recurrence or progression of the cancer. Indeed, product information packaging for testosterone products includes FDA-mandated language stating that TRT is contraindicated in men with a history of, or suspicion of prostate cancer.However, scientific literature fails to provide support for this concept. The origin of the concern stems from the landmark work by Huggins and co-workers, who reported in 1941 that severe reductions in serum T by castration or estrogen therapy caused regression of prostate cancer (PCa), and also that administration of T caused “enhanced growth” of PCa. Remarkably, the assertion by Huggins regarding the “enhanced growth” of PCa was based on a single patient. A number of reports prior to 1982 described the use of daily T injections in men with advanced PCa, with some men experiencing subjective benefits, and without any indication of unexpected disease progression. Although there is little modern experience with administration of T in men with known history of PCa, there is a varied and extensive literature indicating that higher T does not pose any increased risk of PCa growth, in men with or without prior treatment. For instance, the cancer rate in TRT trials is only approximately 1%, similar to detection rates in screening programs, yet biopsy detectable PCa is found in one of seven hypogonadal men. Moreover, PCa is almost never seen in the peak T years of the early twenties despite autopsy evidence that men in this age group already harbor microfoci of PCa in substantial numbers. Finally, a recent report showed that concentrations of T and DHT within the prostate were unchanged after 6 months of TRT, thus providing an explanation why TRT may not cause increased PCa growth.The growing number of PCa survivors who happen to be hypogonadal and requesting treatment has spurred a change in attitude toward this topic, with increasing numbers of physicians now offering TRT to men who appear cured of their disease. Publications have now reported no PSA recurrence with TRT in small numbers of men who had undetectable PSA values following radical prostatectomy. Although still controversial, there appears little justification to withhold TRT from men with favorable outcomes after definitive treatment for PCa.KeywordsTestosteroneandrogenprostate cancerhypogonadismtestosterone replacement therapylibidoerectile dysfunction" @default.
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• W43074641 date "2009-01-01" @default.
• W43074641 modified "2023-09-25" @default.
• W43074641 title "Androgen Supplementation in the Prostate Cancer Patient" @default.
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• W43074641 doi "https://doi.org/10.1007/978-1-60327-555-2_15" @default.
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