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Testosterone And Prostate Cancer 2020

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Prostate Cancer The Facts

Taking Testosterone During Intermittent Hormone Therapy | Mark Moyad, MD, MPH & Mark Scholz, MD

Cancer is a word nobody likes to hear. A group of diseases that entail abnormal cell growth, where the cells reproduce uncontrollably. Those cells can potentially invade or spread to other parts of the body. We often think of cancer as the end of the road, but thats not true we can fight it.

Based on 2018 estimates, there was well over one million new cases of prostate cancer reported worldwide in 2018. Prostate cancer is the second most frequent cause of cancer in men, with lung cancer being first, and the 5th leading cause of death worldwide 1. Both the incidence and mortality of prostate cancer correlate with an increased age, where the average age at time of diagnosis is 66 years 1.

Prostate cancer may often be asymptomatic during the early stages. Therefore, you are encouraged to get your prostate checked out at your later years of life. Yes, this means a finger in the bum, but its better than having cancer. Generally, the first symptoms noticed may be difficulty with urination, an increased frequency of urination, and nocturia , which often occurs due to prostatic hypertrophy 1. As the cancer develops, one may notice urinary retention and back pain.

On a more positive note, the 5-year survival rate among men in the USA diagnosed with prostate cancer is ~98% 2 and among patients diagnosed between 2003 to 2007 in Europe it was 83%, with a higher survival rate among southern and central European countries at 88% 3.

Testosterone Therapy Safe Despite Prostate Cancer

CHICAGOStudies presented at the 2019 American Urological Association annual meeting add to a growing body of evidence showing that testosterone replacement therapy is safe for selected men with a history of prostate cancer .

Thestudies found no increase in the risk of adverse oncologic outcomes followingtreatmenteven among men with high-risk PCaor while on active surveillance. Twoof these studies were co-led by J. Kellogg Parsons, MD, MHS, Professor of Urologyat the University of California, San Diego, who told Renal & Urology News he believes the research to date, despitebeing mainly observational cohort studies, is sufficient to support the use ofTRT in selected men with low-risk PCa, particularly those who have undergonedefinitive treatment with surgery or radiation and have no evidence of residualdisease.

Hormone Therapy For Prostate Cancer

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Hormone therapy is also called androgen suppression therapy. The goal of this treatment is to reduce levels of male hormones, called androgens, in the body, or to stop them from fueling prostate cancer cell growth.

Androgens stimulate prostate cancer cells to grow. The main androgens in the body are testosterone and dihydrotestosterone . Most androgens are made by the testicles, but the adrenal glands as well as the prostate cancer cells themselves, can also make androgens.

Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. But hormone therapy alone does not cure prostate cancer.

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When The Valves Wear Out

If the ISV malfunctions, blood pools in the veins directly above the testicle. The veins begin to bulge with extra blood, and the pressure of the pooled blood is greater than the flow pressure from the prostate. While the majority of ISV blood will still make its way to the rest of the body, some of it is forced upward into the prostate gland. The blood that heads to the rest of the body will carry the majority of testosterone produced by the testicles, since it is bound with blood proteins. However, the majority of free testosterone the kind most readily available for tissue absorption is not traveling with those proteins. Instead, the blood that backflows to the prostate is saturated with free testosterone, reaching concentrations up to 130 times greater than free testosterone in circulating blood! This means the gland is literally bathing in free testosterone. It also means that free testosterone levels will be lower when a testosterone blood draw is taken.

What Is Intermittent Adt

Low Testosterone is a Risk Factor for Prostate Cancer

Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.

Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .

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Testosterone Therapy And Prostate Health

Men with a clinical picture of hypogonadism and biochemical confirmation of abnormally low T levels are candidates for TTh if no specific contraindications exist.24 Current evidence suggests that hypogonadal men can receive TTh safely as far as prostate health is concerned.25 However, regular monitoring during treatment needs to include the recommendations of baseline documentation of a digital rectal examination and prostatic-specific antigen determination. It is also recommended that these should be repeated every three months during the first year of TTh and yearly thereafter.24

It is consistent with current knowledge that re-establishing eugonadism should not impose additional risk of developing PCa. The aim of treatment is to maintain T levels within normal limits. It is not completely clear if a hypergonadic status may be detrimental to prostate health, but it also might translate in significant negative developments in other organ systems .26,27

What The Researchers Did

Dr. Crawfords team reviewed clinical data from nearly 23,000 men who were given ADT injections between 2007 and 2016. Each mans treatment varied by how their ADT was formulated. Some types of ADT are given once a month, and others are given at three-, four-, or six-month intervals. The researchers wanted to know how many men were late on their ADT treatments, and how that would affect the amounts of testosterone in their blood.

During this research, the investigators defined month in two ways: either as one lasting 28 days, which is how months were defined during the clinical trials that set dosing schedules for ADT, or as a calendar month lasting 31 days. ADT was deemed late if it was given after day 28 by the first definition or after day 32 by the second definition.

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Testosterone And Prostate Cancer

Posted by Dr Colin Holloway

This study showed that the more testosterone men received, the lower the chance of getting prostate cancer . This is good news for most aging men.

Association of the extent of therapy with prostate cancer in those receiving testosterone therapy in a US commercial insurance claims database

David S. LopezDanmeng HuangKonstantinos K. TsilidisMohit KheraStephen B. WilliamsRandall J. UrbanOrestis A. PanagiotouYongfang KuoJacques BaillargeonAlbert FariasTrudy Krause First published: 09 September 2019 Albert Farias and Trudy Krause contributed equally to this work.

Funding information:

David S. Lopez was supported by the National Institute of Aging at the National Institutes of Health, Grant 1P30AG05930101.PDFToolsGet access to the full version of this article.View access options below.

What Are Male Sex Hormones

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Hormones are substances that are made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs.

Androgens are a class of hormones that control the development and maintenance of male characteristics. The most abundant androgens in men are testosterone and dihydrotestosterone .

Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make . Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells . Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells to grow .

Almost all testosterone is produced in the testicles a small amount is produced by the adrenal glands. Although prostate cells do not normally make testosterone, some prostate cancer cells acquire the ability to do so .

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Remission And The Chance Of Recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.

A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.

How Prostate Cancer Is Treated

In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.

The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.

Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.

Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:

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Testosterone Therapy Administration And Risks

Testosterone therapy comes in different formulations, including short or long-acting injections, creams, gels, and transdermal patches. Additionally, there is an approved oral treatment option.

There is variability in the way that men will respond to testosterone therapy. For some people, the impact of testosterone replacement is prompt and dramatic. In other men, even after an adequate trial period of six months, a noticeable benefit may be lacking.

The only way to know for sure whether you will benefit from testosterone is to give it an adequate trial period.

Testosterone replacement can increase the risk of blood clots. Long-term testosterone replacement therapy is associated with an increased risk of cardiovascular problems, including heart attacks and strokes, particularly in older males.

  • Lab Tests Online. Testosterone.

  • The Effect Of The Free Testosterone Bath

    Saw Palmetto in 2020

    Now we circle back to the connection between testosterone and prostate cancer. According to Gats publication, when the abnormal valves lead to a concentration of free testosterone in the prostate, this hormone places constant stress on the genes that respond to it. This stress pushes cell mutations, as an increasing number of genetic errors occurs and the cells mechanism for detecting copy errors is increasingly damaged. The authors theorize that rapid proliferation of prostate cells results, leading to the condition known as benign prostatic hyperplasia , and eventually to prostate cancer in many cases. So yes, there is a causal link between testosterone and prostate cancer but its not found on the path decades of research has followed.

    Gats work illuminates the problem of two different testosterone effects: total testosterone circulating in the blood vs. a localized saturation of free testosterone affecting the prostate gland. The results of studies showing that testosterone supplementation to treat low T did not affect prostate cancer were puzzling to those who expected the cancer to run wild. However, if Gat is correct, its not serum blood levels that are cancer-causing. Its the pooling and backflow of testicular venous blood saturating the gland thats the source. No wonder the efforts to find a correlation between serum levels of testosterone and prostate cancer ended up with frustration.

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    Intermittent Versus Continuous Hormone Therapy

    Most prostate cancers treated with hormone therapy become resistant to this treatment over a period of months or years. Some doctors believe that constant androgen suppression might not be needed, so they advise intermittent treatment. This can allow for a break from side effects like decreased energy, sexual problems, and hot flashes.

    In one form of intermittent hormone therapy, treatment is stopped once the PSA drops to a very low level. If the PSA level begins to rise, the drugs are started again. Another form of intermittent therapy uses hormone therapy for fixed periods of time for example, 6 months on followed by 6 months off.

    At this time, it isnt clear how this approach compares to continuous hormone therapy. Some studies have found that continuous therapy might help men live longer, but other studies have not found such a difference.

    Testosterone Laboratory Blood Testing

    Blood tests are a factor that is used to determine whether testosterone replacement is needed. If you are having your testosterone level checked with a home test or at a laboratory as ordered by your doctor, your results might not be clear-cut.

    Issues that affect blood levels of testosterone:

    • Testosterone blood levels are higher in the morning and lower in the evening. A test drawn at 4 pm that was low may simply be outside the normal range due to the time of day the blood was taken.
    • There are two types of testosterone tests: total testosterone and free testosterone. Most routine tests only measure total testosterone. However, free testosterone is a much more accurate measure of the physiologic activity of testosterone.

    Making a decision about your need for testosterone therapy is not based solely on the level of testosterone in your blood. It is equally important to consider your symptoms and whether they are indicative of low testosterone levels.

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    Prostate Cancer Risk And Testosterone Supplements

    Testosterone and estrogen are primary sex hormones. Both men and women produce testosterone, but men make more. Testosterone is produced mainly by the testes, increases as a boy matures and is responsible for the maturity of sex organs, increased body and facial hair, muscle mass, and a deeper voice. It also promotes sperm production. Testosterone levels fluctuate over your lifespan but begin declining after age 30. This may result in less interest in sex later in life and possibly fewer firm erections, as well as softer muscle tone.

    Hypogonadism is the condition that occurs when the body doesnt produce enough testosterone on its own. Testosterone replacement therapy can be used to treat hypogonadism. The Endocrine Society recommends offering testosterone therapy to people with symptoms of testosterone deficiency. In men over 65, treatment should only be initiated on an individual basis and after consultation with the person regarding risks and benefits.1

    High Dose Testosterone Causes Dna Damage And Suppresses Prostate Cancer Growth

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    Posted July 28, 2020 Michael Schweizer, M.D., University of Washington

    Since the discovery that blocking hormones can slow the growth of cancer cells in the 1960s, androgen deprivation therapy has been the standard treatment for prostate cancer. This mode of therapy seeks to either stop the production or the activity of androgens, such as testosterone, in the body to treat the disease – a process termed castration. This depletion of testosterone is associated with many debilitating side effects for men that lessen the quality of life, such as lower energy and diminished libido. Eventually, prostate cancer cells often mutate to increase sensitivity towards low concentrations of testosterone to trigger tumor growth leading to castration resistance. This increasing arms race is difficult to control and often progresses to metastatic disease and death.

    Based on their investigation, they have launched a Phase II clinical trial testing the combination of high dose testosterone with Olaparib, a drug that inhibits DNA damage repair and has recently received FDA approval for the treatment of prostate cancer. Importantly, the increase of testosterone associated with this treatment helps patients feel more active during treatment, improving their quality of life. They hope that combining these therapies will be synergistically effective for treating castration-resistant prostate cancer.



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