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Yassin A, Alwani M, Al-Zoubi RM, Aboumarzouk OM, Talib R, Nettleship J, Kelly D, Albaba B. Voiding function improves under long-term testosterone treatment (TTh) in hypogonadal men, independent of prostate size. Int Urol Nephrol 2023:10.1007/s11255-023-03602-4. [PMID: 37148486 DOI: 10.1007/s11255-023-03602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/12/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Functional hypogonadism is a condition in which some, but not all, older men have low testosterone levels. Rather than chronological age per se, the causality of hypogonadism includes obesity and impaired general health (e.g., metabolic syndrome). An association between testosterone deficiency and lower urinary tract symptoms (LUTS) has been reported, yet due to prostate safety concerns, men with severe LUTS (IPSS score > 19) have invariably been excluded from entering testosterone trials. Irrespective, exogenous testosterone has not been demonstrated to cause de novo or worsen mild to moderate LUTS. OBJECTIVE This study investigated whether long-term testosterone therapy (TTh) could have a protective effect on improving the symptoms of LUTS in hypogonadal men. However, the exact mechanism by which testosterone exerts is beneficial effect remains uncertain. PATIENTS AND METHODS In this study 321 hypogonadal patients with an average age of 58.9 ± 9.52 years received testosterone undecanoate in 12-week intervals for 12 years. One hundred and forty-seven of these males had the testosterone treatment interrupted for a mean of 16.9 months before it was resumed. Total testosterone, International Prostate Symptom Scale (IPSS), post-voiding residual bladder volume and aging male symptoms (AMS) were measured over the study period. RESULTS Prior to TTh interruption, it was observed that testosterone stimulation improved the men's IPSS, AMS and post-voiding residual bladder volume, while their prostate volume significantly increased. During the TTh interruption, there was a significant worsening in these parameters, although the increase in prostate volume continued. When TTh was resumed, these effects were reversed, implying that hypogonadism may require lifelong treatment.
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Affiliation(s)
- Aksam Yassin
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation and Men's Health, Doha, Qatar
- Center of Medicine and Health Sciences, Dresden International University, Dresden, Germany
- Weill Cornell School of Medicine, Urology, Doha, Qatar
| | - Mustafa Alwani
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation and Men's Health, Doha, Qatar
| | - Raed M Al-Zoubi
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation and Men's Health, Doha, Qatar.
- Department of Biomedical Sciences, QU-Health, College of Health Sciences, Qatar University, 2713, Doha, Qatar.
- Department of Chemistry, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan.
| | - Omar M Aboumarzouk
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation and Men's Health, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- School of Medicine, Dentistry and Nursing, The University of Glasgow, Glasgow, UK
| | - Raidh Talib
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation and Men's Health, Doha, Qatar
| | - Joanne Nettleship
- Biomolecular Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Daniel Kelly
- Biomolecular Research Centre, Sheffield Hallam University, Sheffield, UK
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK
| | - Bassam Albaba
- Center of Medicine and Health Sciences, Dresden International University, Dresden, Germany
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Gritsina G, Gao WQ, Yu J. Transcriptional repression by androgen receptor: roles in castration-resistant prostate cancer. Asian J Androl 2019; 21:215-223. [PMID: 30950412 PMCID: PMC6498738 DOI: 10.4103/aja.aja_19_19] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/12/2019] [Indexed: 01/02/2023] Open
Abstract
Androgen receptor (AR), a hormonal transcription factor, plays important roles during prostate cancer progression and is a key target for therapeutic interventions. While androgen-deprivation therapies are initially successful in regressing prostate tumors, the disease ultimately comes back as castration-resistant prostate cancer (CRPC) or at the late stage as neuroendocrine prostate cancer (NEPC). CRPC remains largely dependent on hyperactive AR signaling in the milieu of low androgen, while NEPC is negative of AR expression but positive of many AR-repressed genes. Recent technological advances in genome-wide analysis of transcription factor binding sites have revealed an unprecedented set of AR target genes. In addition to its well-known function in activating gene expression, AR is increasingly known to also act as a transcriptional repressor. Here, we review the molecular mechanisms by which AR represses gene expression. We also summarize AR-repressed genes that are aberrantly upregulated in CRPC and NEPC and represent promising targets for therapeutic intervention.
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Affiliation(s)
- Galina Gritsina
- Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Wei-Qiang Gao
- Med-X Research Institute and School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jindan Yu
- Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL 60611, USA
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Miah S, Tharakan T, Gallagher KA, Shah TT, Winkler M, Jayasena CN, Ahmed HU, Minhas S. The effects of testosterone replacement therapy on the prostate: a clinical perspective. F1000Res 2019; 8:F1000 Faculty Rev-217. [PMID: 30828436 PMCID: PMC6392157 DOI: 10.12688/f1000research.16497.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 12/28/2022] Open
Abstract
Male hypogonadism is a clinical syndrome characterized by low testosterone and symptoms of androgen deficiency. Prostate cancer remains a significant health burden and cause of male mortality worldwide. The use of testosterone replacement therapy drugs is rising year-on-year for the treatment of androgen deficiency and has reached global proportions. As clinicians, we must be well versed and provide appropriate counseling for men prior to the commencement of testosterone replacement therapy. This review summarizes the current clinical and basic science evidence in relation to this commonly encountered clinical scenario. There is gathering evidence that suggests, from an oncological perspective, that it is safe to commence testosterone replacement therapy for men who have a combination of biochemically confirmed androgen deficiency and who have either had definitive treatment of their prostate cancer or no previous history of this disease. However, patients must be made aware and cautioned that there is a distinct lack of level 1 evidence. Calls for such studies have been made throughout the urological and andrological community to provide a definitive answer. For those with a diagnosis of prostate cancer that remains untreated, there is a sparsity of evidence and therefore clinicians are "pushing the limits" of safety when considering the commencement of testosterone replacement therapy.
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Affiliation(s)
- Saiful Miah
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
- Division of Surgery and Interventional Science, University College London Medical School, 21 University Street, London, WC1E 6AU, UK
| | - Tharu Tharakan
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Kylie A Gallagher
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Taimur T Shah
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Mathias Winkler
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Channa N Jayasena
- Section of Investigative Medicine, Department of Medicine, Imperial College London, London, W12 0NN, UK
| | - Hashim U Ahmed
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Suks Minhas
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
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Ramos L, Patel AS, Ramasamy R. Testosterone replacement therapy for physician assistants and nurse practitioners. Transl Androl Urol 2018; 7:S63-S71. [PMID: 29644169 PMCID: PMC5881199 DOI: 10.21037/tau.2017.12.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Physician assistants (PA) and nurse practitioners have been moving toward specialty practices, like urology. With increased training and education, they manage more complex conditions independently. Whether they are the primary provider or the follow up to a specialist, physician extenders can play a vital role in managing patients undergoing testosterone therapy. Physician extenders should be able to understand the indications, risks and associated adverse effects of administering testosterone in order to proficiently take care of patients with low testosterone. The goal of this review is to recognize the role and the limits to which physician extenders should manage hypogonadism, and when physician collaboration or referral is necessary.
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Affiliation(s)
- Libert Ramos
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amir Shahreza Patel
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Yassin A, Nettleship JE, Talib RA, Almehmadi Y, Doros G. Effects of testosterone replacement therapy withdrawal and re-treatment in hypogonadal elderly men upon obesity, voiding function and prostate safety parameters. Aging Male 2016; 19:64-9. [PMID: 26742589 DOI: 10.3109/13685538.2015.1126573] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Whether testosterone replacement therapy (TRT) is a lifelong treatment for men with hypogonadism remains unknown. We investigated long-term TRT and TRT withdrawal on obesity and prostate-related parameters. Two hundred and sixty-two hypogonadal patients (mean age 59.5) received testosterone undecanoate in 12-week intervals for a maximum of 11 years. One hundred and forty-seven men had TRT interrupted for a mean of 16.9 months and resumed thereafter (Group A). The remaining 115 patients were treated continuously (Group B). Prostate volume, prostate-specific antigen (PSA), residual voiding volume, bladder wall thickness, C-reactive protein (CRP), aging male symptoms (AMS), International Index of erectile function - erectile function (IIEF-EF) and International Prostate Symptoms Scores (IPSS) were measured over the study period with anthropometric parameters of obesity, including weight, body mass index (BMI) and waist circumference. Prior to interruption, TRT resulted in improvements in residual voiding volume, bladder wall thickness, CRP, AMS, IIEF-EF, IPSS and obesity parameters while PSA and prostate volume increased. TRT interruption reduced total testosterone to hypogonadal levels in Group A and resulted in worsening of obesity parameters, AMS, IPSS, residual voiding volume and bladder wall thickness, IIEF-EF and PSA while CRP and prostate volume were unchanged until treatment resumed whereby these effects were reversed. TRT interruption results in worsening of symptoms. Hypogonadism may require lifelong TRT.
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Affiliation(s)
- Aksam Yassin
- a Institute of Urology & Andrology , Norderstedt , Germany
- b Department of Preventive Medicine, Men's Health Programme , Dresden International University , Dresden , Germany
- c Department of Urology , School of Medicine, Gulf Medical University , Ajman , UAE
| | | | - Raidh A Talib
- e Department of Urology & Andrology , Hamad Medical Corporation , Doha , Qatar , and
| | | | - Gheorge Doros
- f Boston University School of Public Health , Boston , MA , USA
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6
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Minkin MJ. Sexual health and relationships after age 60. Maturitas 2016; 83:27-32. [DOI: 10.1016/j.maturitas.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 01/09/2023]
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Dean JD, McMahon CG, Guay AT, Morgentaler A, Althof SE, Becher EF, Bivalacqua TJ, Burnett AL, Buvat J, El Meliegy A, Hellstrom WJ, Jannini EA, Maggi M, McCullough A, Torres LO, Zitzmann M. The International Society for Sexual Medicine's Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men. J Sex Med 2015; 12:1660-86. [DOI: 10.1111/jsm.12952] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Morgentaler A, Conners III WP. Testosterone therapy in men with prostate cancer: literature review, clinical experience, and recommendations. Asian J Androl 2015; 17:206-11. [PMID: 25652633 PMCID: PMC4650486 DOI: 10.4103/1008-682x.148067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 11/04/2022] Open
Abstract
For several decades any diagnosis of prostate cancer (PCa) has been considered an absolute contraindication to the use of testosterone (T) therapy in men. Yet this prohibition against T therapy has undergone recent re-examination with refinement of our understanding of the biology of androgens and PCa, and increased appreciation of the benefits of T therapy. A reassuringly low rate of negative outcomes has been reported with T therapy after radical prostatectomy (RP), radiation treatments, and in men on active surveillance. Although the number of these published reports are few and the total number of treated men is low, these experiences do provide a basis for consideration of T therapy in selected men with PCa. For clinicians considering offering this treatment, we recommend first selecting patients with low grade cancers and undetectable prostate-specific antigen following RP. Further research is required to define the safety of T therapy in men with PCa. However, many patients symptomatic from T deficiency are willing to accept the potential risk of PCa progression or recurrence in return for the opportunity to live a fuller and happier life with T therapy.
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Affiliation(s)
- Abraham Morgentaler
- Men's Health Boston, 200 Boylston St, Suite A309, Chestnut Hill, MA 02467, USA
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Kühn CM, Strasser H, Romming A, Wullich B, Goebell PJ. Testosterone Replacement Therapy in Hypogonadal Men Following Prostate Cancer Treatment: A Questionnaire-Based Retrospective Study among Urologists in Bavaria, Germany. Urol Int 2015; 95:153-9. [DOI: 10.1159/000371725] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 12/20/2014] [Indexed: 11/19/2022]
Abstract
Background: Several reports suggest testosterone replacement therapy (TRT) may be an option in selected hypogonadal patients with a history of prostate cancer (PCa) and no evidence of disease after curative treatment. Our aim was to assess TRT experience and patient management among urologists in Bavaria. Materials and Methods: Questionnaires were developed and mailed to all registered urologists in Bavaria (n = 420) regarding their experience with TRT in patients with treated PCa. Results: One hundred and ninety-three (46%) urologists returned the questionnaire and reported their experience with TRT in hypogonadal patients after curative treatment for PCa. Complete data was available for 32 men. Twenty-six patients (81%) received TRT after prostatectomy, 1 patient after external beam radiation, 3 patients after high-dose brachytherapy and 2 patients after high-intensity focused ultrasound. Of the PCa cases, 88.5% (23/26) were organ confined (pT2a-c), and 3 were pT3 tumors. All patients were pN0/cN0, and only 1 patient (pT3a) had a positive surgical margin status postoperatively. After a mean follow-up of 39.8 months, no biochemical relapse was observed. Conclusion: To date, there is no clear evidence to withhold TRT from hypogonadal men after curative PCa treatment. Our findings, although with limitations, fit in with the available data showing that TRT does not put patients at an increased risk after curative treatment of PCa.
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Abstract
Hypogonadism is common throughout the illness trajectory of patients with cancer. About two thirds of male patients with advanced cancer have hypothalamic-pituitary-gonadal dysfunction and low testosterone levels. Chronic inflammation, comorbidities, cachexia, chemotherapy, and medications such as opioids, megestrol acetate, and corticosteroids contribute to primary and secondary hypogonadism. Studies have reported increased symptom burden, diminished quality of life, and poor prognosis associated with low testosterone levels in males with cancer. The Endocrine Society has published clinical practice guidelines for replacing testosterone in symptomatic patients with chronic illness and in patients receiving opioids; however, the role of testosterone therapy specifically in patients with cancer is not addressed. This review explores the potential benefits and limitations of testosterone replacement on the basis of current evidence.
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Abstract
Testosterone replacement therapy (TRT) is a widely used treatment for men with symptomatic hypogonadism. The benefits seen with TRT, such as increased libido and energy level, beneficial effects on bone density, strength and muscle as well as cardioprotective effects, have been well-documented. TRT is contraindicated in men with untreated prostate and breast cancer. Men on TRT should be monitored for side-effects such as polycythemia, peripheral edema, cardiac and hepatic dysfunction.
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Affiliation(s)
- E Charles Osterberg
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, Starr 900, New York, NY, USA
| | - Aaron M Bernie
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, Starr 900, New York, NY, USA
| | - Ranjith Ramasamy
- Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, Starr 900, New York, NY, USA
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Controversies in Diagnosis and Treatment of Hypogonadism. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-014-0013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Skeletal lesions are a frequent complication of breast and prostate cancer and a hallmark of multiple myeloma. Endocrine and paracrine factors modulate various aspects of bone metastases, including tumour proliferation, skeletal susceptibility to tumour homing, the microenvironment needed to support tumour persistence, and the initiation of a vicious cycle between tumour and bone-resident cells that further promotes tumour growth. Endocrine changes, such as oestrogen or vitamin D deficiency, contribute to a fertile bone microenvironment that might promote bone metastases. Bone health could be impaired further by existing cancer treatments, especially sex hormone deprivation. In this Review, we discuss the effect of hormones and associated local factors on cross-talk between bone metabolism and tumour biology. We review the biology of osteolytic and osteosclerotic lesions, with a focus on endocrine aspects, and outline potential therapeutic targets. We also summarise endocrine aspects of the pathogenesis and clinical presentation of bone metastases and provide an update on existing and future treatments.
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Affiliation(s)
- Lorenz C Hofbauer
- Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, TU Dresden, Dresden, Germany; Centre for Regenerative Therapies Dresden, TU Dresden, Dresden, Germany.
| | - Tilman D Rachner
- Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, TU Dresden, Dresden, Germany
| | - Robert E Coleman
- Sheffield Cancer Research Centre, Weston Park Hospital, Sheffield, UK
| | - Franz Jakob
- Orthopaedic Center for Musculoskeletal Research, Wuerzburg, Germany
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Cooper LA, Page ST. Androgens and prostate disease. Asian J Androl 2014; 16:248-55. [PMID: 24407178 PMCID: PMC3955334 DOI: 10.4103/1008-682x.122361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/23/2013] [Accepted: 07/23/2013] [Indexed: 11/04/2022] Open
Abstract
A growing body of literature has established the anabolic benefi ts of testosterone (T) therapy in hypogonadal men. However, there remains a paucity of data regarding the risks of exogenous androgen use in older men and the potential for adverse effects on the prostate gland. Whether T therapy in older, hypogonadal men might worsen lower urinary tract symptoms or exacerbate, unmask, or even incite prostate cancer development has tempered enthusiasm for T therapy, while known prostatic disease has served as a relative contraindication to T therapy. Androgens are necessary for the development and maintenance of the prostate gland. However, epidemiologic studies do not consistently fi nd a positive relationship between endogenous serum androgen concentrations and the risk of prostate disease. Recent data demonstrate that 5α-reductase inhibitors decrease the risk of low-grade prostate cancer, suggesting that modifying androgen metabolism may have beneficial effects on prostate health, yet similar reductions in high-grade disease have not been observed, thereby questioning the true clinical benefits of these agents for chemoprevention. Knowing how to best investigate the relationship between androgens and the development of prostate disease given the lack of large, randomized trials is difficult. Accumulating data challenges the assumption that alterations in serum androgens have parallel effects within the prostate hormonal environment or change androgen-regulated processes within the gland. Long-term intervention studies are needed to truly ascertain the effects of androgen manipulation on prostate tissue and disease risk. However, available data do not support the notion that restoring serum androgens to normal physiologic ranges drives prostate disease.
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Affiliation(s)
- Lori A Cooper
- Department of Medicine, Division of Endocrinology and Metabolism, University of Washington, Seattle, USA
| | - Stephanie T Page
- Department of Medicine, Division of Endocrinology and Metabolism, University of Washington, Seattle, USA
- University of Washington and Harborview Medical Center, Seattle, Washington, USA
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Kaplan AL, Trinh QD, Sun M, Carter SC, Nguyen PL, Shih YCT, Marks LS, Hu JC. Testosterone replacement therapy following the diagnosis of prostate cancer: outcomes and utilization trends. J Sex Med 2014; 11:1063-1070. [PMID: 24443943 DOI: 10.1111/jsm.12429] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Late-onset hypogonadism may impair quality of life and contribute to metabolic and cardiovascular comorbidity in aging men. Testosterone replacement therapy is effective in treating hypogonadism. However, for the millions of men with a history of prostate cancer, exogenous testosterone has long been considered contraindicated, even though little data in such men are available. Clarification of this safety issue could allow treatment to be considered for a sizeable segment of the aging male population. AIM The aim of this study is to examine population-based utilization and impact of testosterone replacement therapy in men with prostate cancer. METHODS Using linked Surveillance, Epidemiology, and End Results-Medicare data, we identified 149,354 men diagnosed with prostate cancer from 1992 to 2007. Of those, 1181 (0.79%) men received exogenous testosterone following their cancer diagnosis. We used propensity scoring analysis to examine the effect of testosterone replacement on the use of salvage hormone therapy and overall and prostate cancer-specific mortality. MAIN OUTCOME MEASURES We assessed overall mortality, cancer-specific mortality, and the use of salvage hormone therapy. RESULTS Following prostate cancer diagnosis, testosterone replacement was directly related to income and educational status and inversely related to age (all P < 0.001). Men undergoing radical prostatectomy and men with well-differentiated tumors were more likely to receive testosterone (all P < 0.001). On adjusted analysis, testosterone replacement therapy was not associated with overall or cancer-specific mortality or with the use of salvage hormone therapy. CONCLUSIONS In this population-based observational study of testosterone replacement therapy in men with a history of prostate cancer, treatment was not associated with increased overall or cancer-specific mortality. These findings suggest testosterone replacement therapy may be considered in men with a history of prostate cancer, but confirmatory prospective studies are needed.
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Affiliation(s)
- Alan L Kaplan
- Department of UrologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA.
| | - Quoc-Dien Trinh
- Center for Surgery and Public HealthDivision of Urologic SurgeryBrigham and Women's HospitalBostonMAUSA
| | - Maxine Sun
- Cancer Prognostics Health Outcomes UnitUniversity of Montreal Health CentreMontrealQCCanada
| | - Stacey C Carter
- Department of UrologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Paul L Nguyen
- Department of Radiation OncologyBrigham and Women's HospitalBostonMAUSA
| | - Ya-Chen Tina Shih
- Section of Hospital MedicineDepartment of Medicine Program in the Economics of CancerUniversity of ChicagoChicagoILUSA
| | - Leonard S Marks
- Department of UrologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Jim C Hu
- Department of UrologyDavid Geffen School of Medicine at UCLALos AngelesCAUSA
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Taneja SS. Re: Long-term follow-up of a phase II trial of chemotherapy plus hormone therapy for biochemical relapse after definitive local therapy for prostate cancer. J Urol 2013; 190:880. [PMID: 23931194 DOI: 10.1016/j.juro.2013.05.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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