Testosterone does not increase cancer risk in men treated for prostate cancer

[Nelson Vergel]

Kaplan, A. L., Lenis, A. T., Shah, A., Rajfer, J. and Hu, J. C. (2014), Testosterone Replacement Therapy in Men with Prostate Cancer: A Time-Varying Analysis. Journal of Sexual Medicine. doi: 10.1111/jsm.12768

Abstract
Introduction
The use of testosterone replacement therapy (TRT) in men with prostate cancer is controversial given concerns of androgen-related cancer progression. Although emerging evidence suggests that TRT may be safe in this setting, no study has investigated dose-related effects.

Aim
We used time-varying analysis to determine whether increasing TRT exposure is associated with worse outcomes.

Methods
Using linked Surveillance, Epidemiology, and End Results-Medicare data, we identified 149,354 men diagnosed with prostate cancer from 1991 to 2007. Subjects treated with TRT were stratified by duration of treatment. Weighted propensity score methods were used to adjust for differences between groups. A Cox proportional hazards model was constructed to assess the effect of injectable TRT exposure on outcomes.

Main Outcome Measure
Overall mortality (OM), prostate cancer–specific mortality (PCSM), and use of salvage androgen deprivation therapy (ADT).

Results
Men treated with TRT, regardless of duration, did not experience higher OM or PCSM (all hazard ratio

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 < 1.0, all P ≤ 0.002). We found no difference in use of salvage ADT in the ≤30-day and 31–60 day groups compared with no-TRT (HR 1.23 and 1.05, P = 0.06 and 0.81, respectively), whereas it was lower for men on long-term TRT (HR 0.70, P = 0.04).

Conclusions
TRT following prostate cancer diagnosis and treatment does not increase mortality or the use of salvage ADT. Using time-varying analysis, we demonstrate that longer duration of TRT is not associated with adverse mortality or greater need for ADT.

 

[Paco Cale]

After watching the video from Dr Morgentaler titled 40 perspective on prostate cancer this is what amazed me.

Study of 2011 - testosterone and men with prostate cancer on active surveillance. These men were placed on testosterone injection for 2 1/2 years. all of these men volunteered for biopsies and none of them demonstrated progression of the prostate cancer.

Study 2016, 28 men with untreated prostate cancer were placed for 3 1/2 years on testosterone injection and have not shown any sign of progression of the illness. These men were compared to another group of men with prostate cancer but not in testosterone injection and there were no difference between the two groups as far as progression

Finally there was the story of the Older gentlemen aged of 94 with a PSA of 500 and diagnosed with advance cancer who was taken off testosterone and started feeling really bad and had difficulty walking. This man was placed back on testosterone and now is aged 95. he is active, his brain is clear, he can walk again with a PSA of 1300.

What to think ? Am I still misunderstanding these studies? If I m not, why monitoring PSA so closely to the point of discontinuing treatment when actually low testosterone and estradiol is in no way beneficial to any men besides lowering the PSA score itself. PSA being one of the many and inaccurate pointers helping the detection of PC by monitoring the steady change of level.

why am i seeing, all from official sources, difference in what is considered "acceptable" PSA level sorted by age group? for the group age 60 to 70 (or so) the level of 4.5 is said to be common and acceptable. None of this makes sense to me and to many others I am sure. I certainly do not want to hear Urologists and MDs, by following the lowest denominator, are "protecting" themselves from possible lawsuit. They would be in the wrong business and of extremely poor advice.

any thoughts on this? anybody ?

thanks again

 

[Nelson Vergel]

This is what Dr Rotman, an urologist from New York city said:

"The best marker we have for prostate cancer is still the PSA test. The faster the rise in psa and the higher the score the more likely one is to have advanced prostate cancer. We know by chemically castrating a patient (Lupron etc) one is halting the growth of prostate cancer and lowering the psa. Now when someone has castrate resistant prostate cancer, meaning the testosterone has no effect on cancer growth, testosterone does not play as important part a role anymore and we use alternative treatments such as chemotherapy and other androgen receptor blockers.

In regards to age and psa, as one gets older the prostate tends to grow as well and therefore psa rises as well. We have psa ranges for different ages so as to limit the patients who undergo unnecessary biopsies. So while a psa up to 2.5 is normal for 50 year old patient , a psa up to 4 would be normal for a 70 year old. "

 

[Paco Cale]

This perfectly illustrates my point. One urologist says one thing and another one says something completely different, at least this is how I read it. Dr Rotman may be a more conservative doctor who practice what he learned, and believes. How do we know when we now have access to so much information and we read so much contradicting reports for renowned specialists. I know urologists that the first thing they do is a biopsy and from there, place you on the conveyor for many more to come. I digged through the preventative task force site looking for information and explanation. Doing so, i stumbled on a case where the man went through 11 biopsies before being considered "clean". Needless to say he suffers incontinence and ED. I just watched this video from Dr Morgentaler who apparently is world renowned. In his video, he presented and explained several RECENT case studies, which to me, carried a completely different set of information. It seems, once again, there are different school of thoughts which is really scary and needs to be corrected. If someone or some organization setup a rule, they have to make sure this is "the" rule to follow and that, across the board. This is why i am seeking different professional point of view and if possible, explanations. I consider we have the right to know what is the latest, newest clinical information. Equipped with this knowledge men could stop worrying or make better decision or not let anyone place them on the biopsy conveyor without questioning.
Just a few years back, Saw Palmetto was a God sent. Today... not so much. DHT is the enemy, today... it depends. One day i had a PSA reading of 5.7. The same day i had a result i asked to have the test done again. Two days later i found out it went down 3 points. In less then a week between both blood draws and no explanation were provided but this is enough for many urologists to poke your prostate unnecessarily. I am simply seeking knowledge due to being tired of reading conflicting studies, or having urologist being more concerned by my hematocrit or creatinine then my psa. AFter my urologist retired, i went on a quest to find a good specialist. i drove several times to Miami (3 hours one way) to be received like a dog in a bowling alley because i was on TRT.
For that reason alone, i am starting to contemplate discontinuing TRT.
Hoping i am making sense !!

 

[Paco Cale]

anybody? any Urologist in the group willing to comment? anybody with similar thoughts and/or experience?

 

[luidox33]

anybody? any Urologist in the group willing to comment? anybody with similar thoughts and/or experience?

They dont want to answer. They are hypocrites claiming they practice evidence-based medicine when in fact they're just cowards leaning on 40s doctorine.

UGL source is the answer in these scenerios.

 

[madman]

Testosterone, testosterone therapy and prostate cancer

 

[luidox33]

Testosterone, testosterone therapy and prostate cancer

bipolar androgen treatment still uses ADT btw. Hense the Bipolar destinction. Amd its ONLY for castrate resistance. Its not used any other way. Its not like Your on trt for say 20 years then they give you higher doses as treatment, no, what they do is CRASH your T first, wait that out till your body adapts, then power slam it with super high T levels. Your taking both meds.

If your on T more than 10 years, i dont think advanced stage cancer is a concern. Low grade managable watchful waiting active surveillance with TRT is more likely.

Staying on T is the answer i think. T persistance slows and can reverse cancer.

I mean,...think about it. Low t gas proven track record of problems. High T addresses so many health issues. Why, after long term, would it SUDDENLY allow stage 3-4 PCs to ocvure??? Makes no sense. Especially if your living a healthy life.

 

[madman]

Overturning Dogma -- Using Testosterone in Prostate Cancer
In Subset of Hypogonadal Men

Medscape: Medscape Access




Medscape: Medscape Access

 

[madman]

Links should work now