madman
Super Moderator
In this episode, Dr. Morgentaler and Dr. Brandon discuss the controversial topic of testosterone therapy for men diagnosed with or treated for prostate cancer.
Chapters
00:00: Introduction to Testosterone and Prostate Cancer - Dr. Morgentaler and Dr. Brandon set the stage by addressing common concerns about testosterone therapy for men with prostate cancer.
01:15: Impact of Androgen Deprivation Therapy - They discuss the effects of lowering testosterone on patients undergoing prostate cancer treatment and the long-term implications on quality of life.
03:22: Debunking Myths About Testosterone - The hosts confront the persistent fears surrounding testosterone and its perceived link to cancer recurrence.
07:40: Scientific Evidence and Case Studies - Highlighting studies and patient stories, they provide evidence that challenges outdated beliefs about testosterone therapy.
20:04: The Impact of Metastatic Disease on Life - They explore how metastatic prostate cancer affects physical and emotional well-being, emphasizing the need for balanced treatment approaches.
21:28: Understanding Biochemical Recurrence - The podcast explains the concept of biochemical recurrence, where cancer returns without visible signs, and its implications for therapy.
23:37: Testosterone Therapy After Prostate Cancer - They detail when and how testosterone therapy might be appropriate for patients post-treatment, backed by promising research data.
36:00: Concluding Thoughts and Future Directions - Wrapping up, they advocate for rethinking testosterone therapy guidelines and encourage further research to support evidence-based care.
Can Men Take Testosterone After Being Diagnosed with Prostate Cancer?
Welcome to the Sex Doctors PodcastFeaturing Dr. Maryanne Brandon, a clinical psychologist and certified sex therapist, and Dr. Abraham Morgentaler, a urologist and expert in sexual medicine and testosterone therapy. Together, they discuss crucial topics related to sexual health, intimacy, and relationships.
The Common Question: Testosterone After Prostate Cancer?
Dr. Morgentaler opens the discussion by addressing one of the most frequent questions he receives:
Can men diagnosed with prostate cancer or at risk of it safely take testosterone?
Men with high PSA levels or prior prostate cancer treatment often experience testosterone deficiency and its associated symptoms. Yet many are advised against testosterone therapy due to the lingering fear that it could cause cancer to recur.
Understanding Testosterone and Prostate Cancer
1. The Role of Androgen Deprivation Therapy (ADT):- What is it? ADT lowers testosterone levels to slow prostate cancer growth. This is often combined with radiation therapy to enhance its effectiveness.
- The downside: Many men do not recover their natural testosterone levels after treatment, experiencing debilitating symptoms like fatigue, low libido, and depression.
- Historical fears: The belief that testosterone promotes cancer growth persists despite evidence to the contrary.
- Reality check: Decades of research show no evidence that testosterone increases the risk of cancer recurrence, even in men with prior diagnoses.
The Science Behind Testosterone Therapy
The Saturation Model:- Introduced by Dr. Morgentaler and his colleague, Abdul Traish, this model explains that prostate tissue needs only a small amount of testosterone to function.
- Key insight: Once prostate tissue has enough testosterone (about 250 nanograms per deciliter), adding more doesn’t increase growth. It’s akin to watering a plant—once it’s sufficiently hydrated, more water won’t make it grow faster.
- Cell Studies:
- Prostate cancer cells in a lab become more aggressive when deprived of testosterone. In contrast, normal or high testosterone levels make the cells behave more benignly.
- This challenges the assumption that testosterone fuels cancer growth.
- The Traverse Study (2023):
- The largest randomized controlled trial on testosterone therapy to date.
- Results showed no increase in prostate cancer rates among men treated with testosterone compared to those given a placebo.
- Swedish National Study:
- Men treated with testosterone had a 50% reduction in high-grade prostate cancers compared to untreated men.
- Surgical Outcomes:
- Studies of men who underwent radical prostatectomy (complete removal of the prostate) show that testosterone therapy after surgery does not increase recurrence rates.
- Recent research even suggests that testosterone might lower the likelihood of cancer recurrence.
Addressing Advanced and Recurrent Cancer
Testosterone in Metastatic Cases:Dr. Morgentaler shares compelling stories of men with advanced prostate cancer who chose testosterone therapy despite conventional warnings:
- A 94-year-old man with metastatic prostate cancer and a PSA level over 500 improved his quality of life dramatically after starting testosterone therapy.
- In a study of 22 men with advanced or recurrent cancer, testosterone therapy did not lead to rapid disease progression, contradicting long-held fears.
- Biochemical recurrence: Rising PSA levels after treatment, with no visible cancer on scans.
- Metastatic disease: Cancer that has spread to other areas, such as bones or lymph nodes.
- In both cases, testosterone therapy may be beneficial without worsening cancer outcomes.
Practical Considerations for Testosterone Therapy
When Can Men Safely Start?- Post-surgery: Dr. Morgentaler prefers waiting until PSA levels are undetectable to reassure patients that they appear cancer-free.
- Ongoing cancer: Testosterone therapy can still be an option, depending on individual risk tolerance and quality-of-life goals.
- Testosterone can improve energy, mood, libido, and overall well-being, particularly in men suffering from severe testosterone deficiency.
- However, its impact on erectile function post-surgery is less clear, as nerve recovery plays a significant role.
Breaking Down the Myths
Dr. Morgentaler emphasizes that the fear surrounding testosterone and prostate cancer originates from outdated studies and misconceptions. Modern evidence paints a very different picture:- Testosterone therapy is safe for most men with a history of prostate cancer.
- In some cases, it may even offer protective benefits against cancer recurrence.
Closing Thoughts:
Dr. Brandon and Dr. Morgentaler conclude with a message of hope: Testosterone therapy can significantly improve quality of life for men with prostate cancer histories, and the fears surrounding it are largely unfounded.
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