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Baalbaki G, Lim V, Gillet AP, Verner MA, Vaillancourt C, Caron-Beaudoin E, Delbes G. Trace elements alone or in mixtures associated with unconventional natural gas exploitation affect rat fetal steroidogenesis and testicular development in vitro. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 357:124393. [PMID: 38901820 DOI: 10.1016/j.envpol.2024.124393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/30/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024]
Abstract
Biomonitoring studies have shown that pregnant women living in regions of unconventional natural gas (UNG) exploitation have higher levels of trace elements. Whether developmental endocrine disruption can be expected at these exposure levels during pregnancy is unclear. In this study, we aimed to test the impact of five trace elements alone or in mixtures using in vitro cell- and tissue-based assays relevant to endocrine disruption and development. Manganese, aluminum, strontium, barium, and cobalt were tested at concentrations including those representatives of human fetal exposure. Using transactivation assays, none of the tested elements nor their mixture altered the human estrogen receptor 1 or androgen receptor genomic signalling. In the rat fetal testis assay, an organ culture system, cobalt (5 μg/l), barium (500 μg/l) and strontium (500 μg/l) significantly increased testosterone secretion. Cobalt and strontium were associated with hyperplasia and/or hypertrophy of fetal Leydig cells. Mixing the five elements at concentrations where none had an effect individually stimulated testosterone secretion by the rat fetal testis paralleled by the significant increase of 3β-hydroxysteroid dehydrogenase protein level in comparison to the vehicle control. The mechanisms involved may be specific to the fetal testis as no effect was observed in the steroidogenic H295R cells. Our data suggest that some trace elements in mixture at concentrations representative of human fetal exposure can impact testis development and function. This study highlights the potential risk posed by UNG operations, especially for the most vulnerable populations, pregnant individuals, and their fetus.
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Affiliation(s)
- Ghida Baalbaki
- Institut National de la Recherche Scientifique (INRS), Centre Armand Frappier Santé Biotechnologie, Laval, QC, Canada
| | - Victoria Lim
- Institut National de la Recherche Scientifique (INRS), Centre Armand Frappier Santé Biotechnologie, Laval, QC, Canada
| | - Antoine P Gillet
- Institut National de la Recherche Scientifique (INRS), Centre Armand Frappier Santé Biotechnologie, Laval, QC, Canada
| | - Marc-André Verner
- Université de Montréal, Department of Occupational and Environmental Health, Montreal, QC, Canada; Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Cathy Vaillancourt
- Institut National de la Recherche Scientifique (INRS), Centre Armand Frappier Santé Biotechnologie, Laval, QC, Canada; Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Elyse Caron-Beaudoin
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada; Department of Physical and Environmental Sciences, University of Toronto Scarborough, Toronto, ON, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Geraldine Delbes
- Institut National de la Recherche Scientifique (INRS), Centre Armand Frappier Santé Biotechnologie, Laval, QC, Canada.
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Abstract
Due to late onset hypogonadism (LOH), there is an increased usage of testosterone replacement therapy (TRT) in the aging male population. Since prostate is a target organ for androgens and anti-androgenic strategies are used to treat and palliate benign prostate hyperplasia (BPH) and prostate cancer (PC), the prevalence of both increases with age, the possible influence of TRT on prostate health becomes highly relevant. The present review summarizes existing data on the associations between endogenous hormone concentrations and prostate growth and concludes that circulating concentrations of androgens do not appear to be associated with the risks of development of BPH or initiation or progression of PC. The explanation for these findings relates to an apparent insensitivity of prostatic tissue to changes of testosterone concentrations within the physiological range.
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Affiliation(s)
- Karin Welén
- grid.8761.80000 0000 9919 9582Department of Urology, Institute of Clinical Sciences, Sahlgrenska Center for Cancer Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan-Erik Damber
- grid.8761.80000 0000 9919 9582Department of Urology, Institute of Clinical Sciences, Sahlgrenska Center for Cancer Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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3
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Trends in Testosterone Therapy use in Prostate Cancer Survivors in the United States. J Sex Med 2021; 18:1346-1353. [PMID: 37057458 DOI: 10.1016/j.jsxm.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/10/2021] [Accepted: 06/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Physician prescribing patterns surrounding the use of testosterone therapy (TTh) in men with a history of prostate cancer (CaP) is not well described. AIM To characterize the demographics and usage patterns of testosterone therapy in men with a history of prostate cancer in the United States. METHODS This was a retrospective review using Optum's De-identified Clinformatics Data Mart database. Administrative diagnosis, procedural, pharmacy, and laboratory codes were used to identify male subjects 40 years and older with prostate cancer treated with surgery or radiation between 2003 and 2018 who went on to receive TTh. Demographic and clinical factors are identified. Temporal trends in TTh usage were reported. OUTCOMES The main outcomes were rates of testosterone prescriptions in men with treated prostate cancer and associated laboratory values such as Prostate Specific Antigen (PSA) and testosterone levels before TTh. RESULTS 126,374 men completed treatment for CaP during the study period (42,515 surgery, 75,186 radiation, 8,673 both). Of these, 3,074 men (2.4%) received testosterone after CaP treatment. Men who received testosterone were younger, more likely to have erectile dysfunction, depressive disorder, and lower pretreatment PSA values compared to men who did not receive. Median PSA levels before TTh initiation were 0 - 0.2 depending on CaP treatment modality and median total testosterone level was <300 ng/dL. TTh began an average of 1.5 years after radical prostatectomy and 2.6 years after radiation treatment. We observed an increase in TTh after CaP from the beginning of the study period until it peaked in 2013 at 4.9%. After 2013, rates decreased annually until a plateau of approximately 1.8% of men. Approximately a third of men did not have testosterone labs checked before initiation of TTh. CLINICAL IMPLICATIONS These findings provide insight into trends in testosterone prescriptions in men after prostate cancer treatment and may aid in clinical decision-making, as well as areas for improvement in cancer survivorship care. STRENGTHS AND LIMITATIONS Strengths include the large sample size, length of data coverage, and real-world analysis of testosterone prescribing patterns across the United States. Limitations include the reliance on insurance claims data, the retrospective study design, and lack of additional relevant clinical variables that may impact decision making regarding TTh. CONCLUSION National trends in testosterone prescriptions for men with treated prostate cancer suggest that many men are treated with TTh after prostate cancer therapy with patterns of indications and monitoring consistent with the general population. Chen T, Li S, Eisenberg M. Trends in Testosterone Therapy use in Prostate Cancer Survivors in the United States. J Sex Med 2021;18:1346-1353.
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Xie T, Song XL, Wang C, Yu YZ, Wang JQ, Chen ZS, Zhao SC. The role of androgen therapy in prostate cancer: from testosterone replacement therapy to bipolar androgen therapy. Drug Discov Today 2021; 26:1293-1301. [PMID: 33561465 DOI: 10.1016/j.drudis.2021.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/14/2020] [Accepted: 01/30/2021] [Indexed: 01/01/2023]
Abstract
Testosterone replacement therapy (TRT) is the primary treatment for male testosterone deficiency. This therapy raises concerns over the risk of prostate cancer (PC), because testosterone has historically been considered the fuel for PC. We discuss the re-evaluation of the relationship between androgen and PC, and highlight the safety of TRT in the treatment of symptomatic men with testosterone deficiency who have low-risk disease after treatment for localized PC with surgery or radiation. Furthermore, we review the clinical application and potential mechanisms of bipolar androgen therapy (BAT) in the treatment of castration-resistant PC, emphasizing that much remains to be done before BAT can be broadly applied.
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Affiliation(s)
- Tao Xie
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; Department of Urology, the Third Affiliated Hospital of Southern Medical University, Guangzhou, 510500, China
| | - Xian-Lu Song
- Department of Radiotherapy, Affliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou 510095, China
| | - Chong Wang
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yu-Zhong Yu
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jing-Quan Wang
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, NY 11439, USA
| | - Zhe-Sheng Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, NY 11439, USA.
| | - Shan-Chao Zhao
- Department of Urology, the Third Affiliated Hospital of Southern Medical University, Guangzhou, 510500, China; Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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Choi EJ, Xu P, El-Khatib FM, Huynh LM, Yafi FA. Hypogonadism and its treatment among prostate cancer survivors. Int J Impot Res 2020; 33:480-487. [PMID: 33311575 DOI: 10.1038/s41443-020-00387-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 11/12/2020] [Accepted: 11/24/2020] [Indexed: 01/20/2023]
Abstract
Adult-onset hypogonadism (AOH) is associated with sexual dysfunction, poor bone mineralization, decreased muscle mass, metabolic syndrome disorder, and cognitive suppression. Historically, testosterone has been contraindicated in men with a history of prostate cancer. However, there has been a modern resurgence in re-evaluating this belief. Not only can testosterone be safely utilized to alleviate AOH symptoms in prostate cancer survivors, it has been also touted as a treatment option for aggressive prostatic cancer. While much work remains in understanding the relationship between testosterone and prostate cancer, those who survive this disease should not be automatically turned away from an opportunity to be treated and restored.
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Affiliation(s)
- Edward J Choi
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| | - Perry Xu
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| | - Farouk M El-Khatib
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| | - Linda M Huynh
- Department of Urology, University of California, Irvine Health, Orange, CA, USA
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine Health, Orange, CA, USA.
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Shahine H, Zanaty M, Zakaria AS, Nguyen DD, Couture F, Sadri I, Schwartz R, Arezki A, Elterman D, El-Hakim A, Zorn KC. Oncological safety and functional outcomes of testosterone replacement therapy in symptomatic adult-onset hypogonadal prostate cancer patients following robot-assisted radical prostatectomy. World J Urol 2020; 39:3223-3229. [PMID: 33034733 DOI: 10.1007/s00345-020-03475-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/01/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Testosterone replacement therapy (TRT) remains controversial in men with treated prostate cancer. We assessed its safety and functional impacts in patients after definitive surgical treatment with robotic-assisted radical prostatectomy (RARP). METHODS We performed a retrospective analysis of 1303 patients who underwent RARP during the years 2006-2019. We identified men with symptoms of andropause and low serum testosterone who received TRT post-RARP; then we divided the cohort into two groups accordingly for comparison. Biochemical recurrence (BCR) was the primary endpoint. Secondary endpoints included functional outcomes. Predictors of BCR, including the effect of TRT on BCR, were evaluated using univariable and multivariable logistic regression. RESULTS Among the forty-seven men who received TRT, the mean age was 60.83 years with a median follow-up of 48 months. Three (6.4%) and 157 (12.56%) patients experienced BCR in TRT and non-TRT groups, respectively. Baseline characteristics were similar between both groups except for higher mean BMI in the TRT group (p = 0.03). In the multivariate analysis (MVA), higher pre-RARP prostate-specific antigen (PSA) (p = 0.043), higher International Society of Urological Pathology score (p < 0.001), seminal vesical invasion (p = 0.018) and positive surgical margin (p < 0.001) were predictors of BCR. However, TRT was not (p = 0.389). In addition, there was a significant change in the Sexual Health Inventory for Men (p = 0.022), and serum testosterone level (p < 0.001) before and 6 months after initiation of TRT. CONCLUSION Our findings suggest that TRT, in well-selected, closely followed, symptomatic men post-RARP is an oncologically safe and functionally effective treatment in prostate cancer patients post-RARP.
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Affiliation(s)
- Hanna Shahine
- Département d'Urologie, Robotic Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Marc Zanaty
- Department of Urology, Hopital Rouyn-Noranda, Quebec, Canada
| | - Ahmed S Zakaria
- Département d'Urologie, Robotic Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Felix Couture
- Département d'Urologie, Centre Hospitalier de l'Université de Sherbrooke, Montreal, Canada
| | - Iman Sadri
- School of Medicine, McGill University, Montreal, Canada
| | - Russel Schwartz
- Département d'Urologie, Robotic Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Adel Arezki
- School of Medicine, McGill University, Montreal, Canada
| | - Dean Elterman
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Kevin C Zorn
- Département d'Urologie, Robotic Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada. .,Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada.
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Kim DK, Noh JW, Chang Y, Lee HY, Park JJ, Ryu S, Kim JH. Association between prostate-specific antigen and serum testosterone: A systematic review and meta-analysis. Andrology 2020; 8:1194-1213. [PMID: 32329181 DOI: 10.1111/andr.12806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Serum testosterone assays are an important tool in the clinical evaluation of a number of endocrine disorders including male hypogonadism. However, serum testosterone has a limited role in real clinical use due to its inaccuracy. We aimed to assess the association between prostate-specific antigen (PSA) and testosterone as well as the effects of various types of testosterone replacement therapy (TRT) for PSA level. METHODS Two electronic databases were screened: PubMed (1966 through December 2018) and Cochrane Library (1993 through December 2018). The first strategy compared the overall increase in PSA following testosterone treatment compared with placebo. The second strategy analyzed the overall association between PSA and testosterone among the observational studies. RESULTS In the first strategy, 22 articles were included in the final analysis. In the second strategy, 18 studies were included. Testosterone replacement therapy (TRT) showed a significant change in PSA level compared to that in the placebo group (mean difference [MD]: 0.13, 95% CI: 0.01-0.25, P = .04). Compared to placebo, only intramuscular (IM) TRT shows a significant change in PSA level group (MD: 0.16, 95% CI: 0.01-0.30, P = .04), as neither the oral nor topical type showed a significant change in PSA. In the second strategy analysis, there was no overall correlation found between PSA and testosterone (z = 0.04, 95% CI: -0.04 to 0.12, P = .04; r = 0.039). However, in the subgroup of non-BPH (benign prostate hyperplasia), a significant correlation between PSA and testosterone (z = 0.07, 95% CI: 0.01-0.13, P = .009; r = 0.089) was found. CONCLUSIONS We found that TRT, particularly IM TRT, significantly changed the PSA level compared with the placebo group. Furthermore, there was a significant correlation between PSA and testosterone in patients with non-BPH. According to these findings, we suggest the possibility of PSA as a surrogate marker of testosterone.
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Affiliation(s)
- Do Kyung Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Jin-Won Noh
- Department of Health Administration, Dankook University, Korea.,Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Hyun Young Lee
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Jae Joon Park
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea.,Urological Biomedicine Research Institute, Soonchunhyang University Seoul Hospital, Seoul, South Korea
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8
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Miranda EP, Torres LO. Late-onset hypogonadism: Prostate safety. Andrology 2020; 8:1606-1613. [PMID: 32056383 DOI: 10.1111/andr.12772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/27/2020] [Accepted: 02/11/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND There have always been concerns regarding testosterone replacement therapy and prostate safety because of the central role of testosterone in prostate tissue. Even though there is a body of evidence supporting that the benefits of testosterone replacement therapy outbalance the risks of prostate disease, this matter is still debatable and represents a common concern among testosterone prescribers. OBJECTIVES The aim of this article was to review the influence of testosterone on prostate pathophysiology and discuss the potential impact of testosterone replacement therapy on the most common prostate pathologies, including benign prostatic hyperplasia and prostate cancer. MATERIALS AND METHODS We have performed an extensive PubMed review of the literature examining the effects of testosterone replacement therapy on the prostate and its most common affections, especially in terms of safety. RESULTS Testosterone replacement therapy has been shown to improve components of metabolic syndrome and decrease prostate inflammation, which is related to the worsening of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia. Studies evaluating the link between testosterone replacement therapy and benign prostatic hyperplasia/LUTS have mostly demonstrated no change in symptom scores and even some benefits. There are a significant number of studies demonstrating the safety of testosterone replacement therapy in individuals with late-onset hypogonadism and a history of prostate cancer. The most recently published guidelines have already acknowledged this fact and do not recommend against T treatment in this population, particularly in non-high-risk disease. CONCLUSION Testosterone replacement therapy could be considered for most men with late-onset hypogonadism regardless of their history of prostate disease. However, a discussion about the risks and benefits of testosterone replacement therapy is always advised, especially in men with prostate cancer. Appropriate monitoring is mandatory.
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Affiliation(s)
- Eduardo P Miranda
- Division of Urology, Universidade Federal do Ceara, Fortaleza, Brazil
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9
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Abstract
Introduction: The use of testosterone therapy (TTh) in men with prostate cancer (PCa) is relatively new, and controversial, due to the longstanding maxim that TTh is contraindicated in men with PCa. Scientific advances have prompted a reevaluation of the potential role for TTh in men with PCa, particularly as TTh has been shown to provide important symptomatic and general health benefits to men with testosterone deficiency (TD), including many men with PCa who may expect to live 30-50 years after diagnosis. Areas covered: This review outlines the historical underpinnings of the historical belief that TTh 'fuels' PCa and the experimental and clinical studies that have radically altered this view, including description of the saturation model. The authors review studies of TTh in men with PCa following radical prostatectomy and radiation therapy, in men on active surveillance, and in men with advanced or metastatic PCa. Expert opinion: TTh provides important symptomatic and overall health benefits for men with PCa who have TD. Although more safety studies are needed, TTh is a reasonable therapeutic option for men with low-risk PCa after surgery or radiation. Data in men on active surveillance are limited, but initial reports are reassuring.
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Affiliation(s)
- Abraham Morgentaler
- Beth Israel Deaconess Medical Center, Harvard Medical School, Men's Health Boston , Boston , MA , USA
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10
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Diri MA, Diri B, Yildiz L, Büyükalpelli R. The effect of dutasteride on microscopic and macroscopic changes of testosterone replacement treatment on prostate tissue. Andrologia 2018; 50:e13110. [PMID: 30024036 DOI: 10.1111/and.13110] [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: 03/20/2018] [Revised: 05/31/2018] [Accepted: 06/19/2018] [Indexed: 11/29/2022] Open
Abstract
Testosterone replacement therapy has a growing interest in daily practice; however, debates on its safety for prostate cancer still continue. Dutasteride-a 5α-reductase inhibitor-was shown to be effective in preventing prostate cancer. We therefore aimed to evaluate the effect of testosterone replacement therapy and dutasteride treatment on prostate tissue in castrated rats. Rats were randomised in four groups after bilateral orchidectomy as follows: Group I received testosterone + dutasteride, Group II received only testosterone, Group III had no medical treatment, and Group IV was the control group. After 3 months, rats were sacrificed and laboratory and histopathological examinations were performed. In Groups I and II, prostate volume, T and DHT levels were significantly higher compared to Group III and controls. Groups I and II had also significantly greater preneoplastic histopathological signs; however, in intergroup analyses, Group I showed less premalignant changes compared to Group II. We concluded that dutasteride was effective when combined with testosterone therapy in preventing premalignant histopathological changes in prostate tissue. Further evidence is needed to confirm our findings.
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Affiliation(s)
- Mehmet Akif Diri
- Department of Urology, Aksaray University School of Medicine, Aksaray, Turkey
| | - Banu Diri
- Department of Nephrology, Aksaray University School of Medicine, Aksaray, Turkey
| | - Levent Yildiz
- Department of Pathology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Recep Büyükalpelli
- Department of Urology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Abstract
PURPOSE OF REVIEW The role of testosterone in the development of prostate cancer and the safety of testosterone therapy (TTh) after prostate cancer treatment, or in the setting of active surveillance, remains controversial. There are many concerns about using TTh in men, particularly those with a history of prostate cancer, ranging from a possible increased risk of cardiovascular disease to cancer progression or recurrence. With many prostate cancer patients living longer, and hypogonadism having significant morbidity, much care must go into the decision to treat. Here, we review the literature investigating the effects of testosterone on the prostate as well as the efficacy and safety of exogenous testosterone in men with a history of prostate cancer. RECENT FINDINGS The improvement in quality of life with TTh is well studied and understood, while the argument for significantly increased risk of cancer or other adverse effects is much less robust. Neither increased rates of prostate cancer, cancer recurrence, or cardiovascular risk have been well established. In men with high-risk prostate cancer, evidence in the setting of TTh is very limited, and TTh should be used with caution. The fears of TTh causing or worsening prostate cancer do not appear to be well supported by available data. Though more studies are needed to definitively determine the safety of TTh in men with prostate cancer, consideration should be given to treatment of hypogonadal men with a history of CaP.
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12
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Zakaria AS, Dragomir A, Kassouf W, Tanguay S, Aprikian A. Changes in the levels of testosterone profile over time in relation to clinical parameters in a cohort of patients with prostate cancer managed by active surveillance. World J Urol 2018; 36:1209-1217. [DOI: 10.1007/s00345-018-2270-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 03/13/2018] [Indexed: 12/29/2022] Open
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13
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Golla V, Kaplan AL. Testosterone Therapy on Active Surveillance and Following Definitive Treatment for Prostate Cancer. Curr Urol Rep 2018; 18:49. [PMID: 28589395 PMCID: PMC5486590 DOI: 10.1007/s11934-017-0695-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Previously considered an absolute contraindication, the use of testosterone therapy in men with prostate cancer has undergone an important paradigm shift. Recent data has changed the way we approach the treatment of testosterone deficiency in men with prostate cancer. In the current review, we summarize and analyze the literature surrounding effects of testosterone therapy on patients being treated in an active surveillance protocol as well as following definitive treatment for prostate cancer. RECENT FINDINGS The conventional notion that defined the relationship between increasing testosterone and prostate cancer growth was based on limited studies and anecdotal case reports. Contemporary evidence suggests testosterone therapy in men with testosterone deficiency does not increase prostate cancer risk or the chances of more aggressive disease at prostate cancer diagnosis. Although the studies are limited, men who received testosterone therapy for localized disease did not have higher rates of recurrences or worse clinical outcomes. Current review of the literature has not identified adverse progression events for patients receiving testosterone therapy while on active surveillance/watchful waiting or definitive therapies. The importance of negative effects of testosterone deficiency on health and health-related quality of life measures has pushed urologists to re-evaluate the role testosterone plays in prostate cancer. This led to a paradigm shift that testosterone therapy might in fact be a viable option for a select group of men with testosterone deficiency and a concurrent diagnosis of prostate cancer.
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Affiliation(s)
- Vishnukamal Golla
- Department of Urology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., Box 951738, Los Angeles, CA, 90095-1738, USA
| | - Alan L Kaplan
- Department of Urology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., Box 951738, Los Angeles, CA, 90095-1738, USA.
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14
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Serotonin regulates prostate growth through androgen receptor modulation. Sci Rep 2017; 7:15428. [PMID: 29133842 PMCID: PMC5684231 DOI: 10.1038/s41598-017-15832-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/03/2017] [Indexed: 12/31/2022] Open
Abstract
Aging and testosterone almost inexorably cause benign prostatic hyperplasia (BPH) in Human males. However, etiology of BPH is largely unknown. Serotonin (5-HT) is produced by neuroendocrine prostatic cells and presents in high concentration in normal prostatic transition zone, but its function in prostate physiology is unknown. Previous evidence demonstrated that neuroendocrine cells and 5-HT are decreased in BPH compared to normal prostate. Here, we show that 5-HT is a strong negative regulator of prostate growth. In vitro, 5-HT inhibits rat prostate branching through down-regulation of androgen receptor (AR). This 5-HT’s inhibitory mechanism is also present in human cells of normal prostate and BPH, namely in cell lines expressing AR when treated with testosterone. In both models, 5-HT’s inhibitory mechanism was replicated by specific agonists of 5-Htr1a and 5-Htr1b. Since peripheral 5-HT production is specifically regulated by tryptophan hydroxylase 1(Tph1), we showed that Tph1 knockout mice present higher prostate mass and up-regulation of AR when compared to wild-type, whereas 5-HT treatment restored the prostate weight and AR levels. As 5-HT is decreased in BPH, we present here evidence that links 5-HT depletion to BPH etiology through modulation of AR. Serotoninergic prostate pathway should be explored as a new therapeutic target for BPH.
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15
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Abstract
Testosterone replacement therapy (TRT) represents an increasing popular treatment option for men with late-onset hypogonadism (LOH). Because of unsubstantiated beliefs of testosterone’s effect on the prostate, the FDA has recently placed a warning on testosterone products, stating that TRT may worsen benign prostatic hyperplasia (BPH). Within this review article we have demonstrated the current understanding of the physiology of testosterone and its relationship with prostatic and lower urinary tract physiology. The current evidence suggests that not only does TRT not worsen lower urinary tract symptoms (LUTS), but that hypogonadism itself is an important risk factor for LUTS/BPH.
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Affiliation(s)
- Wesley Baas
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Tobias S Köhler
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
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16
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Abstract
The use of exogenous testosterone to treat hypogonadism in the men with a history of prostate cancer (CaP) remains controversial due to fears of cancer recurrence or progression. Due to the detrimental impact of hypogonadism on patient quality of life, recent work has examined the safety of testosterone therapy (TTh) in men with a history of CaP. In this review, we evaluate the literature with regards to the safety of TTh in men with a history of CaP. TTh results in improvements in quality of life with little evidence of biochemical recurrence or progression in men with a history of CaP, or de novo cancer in unaffected men. An insufficient amount of evidence is currently available to truly demonstrate the safe use of TTh in men with low risk CaP. In men with high-risk cancer, more limited data suggest that TTh may be safe, but these findings remain inconclusive. Despite the historic avoidance of TTh in men with a history of CaP, the existing body of evidence largely supports the safe and effective use of testosterone in these men, although additional study is needed before unequivocal safety can be demonstrated.
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Affiliation(s)
- Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA;; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Morgentaler A, Zitzmann M, Traish AM, Fox AW, Jones TH, Maggi M, Arver S, Aversa A, Chan J, Dobs AS, Hackett GI, Hellstrom WJ, Lim P, Lunenfeld B, Mskhalaya G, Schulman CC, Torres LO. The consensus recommendations of a group of international experts on the fundamental concepts related to the issues of testosterone deficiency and its treatment. ACTA ACUST UNITED AC 2016. [DOI: 10.14341/omet2016315-31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Conference on the development of the international expert consensus to address frequently asked questions related to a medical condition of testosterone deficiency (TD, male hypogonadism) and testosterone therapy was held in Prague (Czech Republic) on October 1, 2015. The included experts were representatives from a variety of medical specialties, including urology, endocrinology, diabetology, internal medicine, as well as representatives of basic medical sciences. An international team of experts came to the following conclusions: TD - an important medical condition that affects the health and well-being of men; TD symptoms is a consequence of low testosterone levels, regardless of whether background etiology installed; TD consequences are global; care must be taken in an attempt to use any uniform threshold levels of testosterone for a decision on the appointment of testosterone therapy; a person does not have any reason to refrain from appointing testosterone therapy only on the basis of age; the existing evidence does not suggest increasing the prostate cancer or cardiovascular disease risk during testosterone therapy; there is evidence conserning the feasibility of a major research initiative to explore possible cardioprotective beneficial effects of testosterone therapy in men with metabolic disorders, including diabetes.
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18
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Nguyen TM, Pastuszak AW. Testosterone Therapy Among Prostate Cancer Survivors. Sex Med Rev 2016; 4:376-88. [PMID: 27474995 PMCID: PMC5026903 DOI: 10.1016/j.sxmr.2016.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The use of testosterone in men with a history of prostate cancer remains controversial in light of established findings linking androgens to prostate cancer growth. However, hypogonadism significantly affects quality of life and has negative sequelae, and the risks and benefits of testosterone therapy might be worthwhile to consider in all men, even those with a history of high-risk prostate cancer. AIM To discuss the effects of testosterone on the prostate and the use of testosterone therapy in hypogonadal men with a history of prostate cancer. METHODS Review of the literature examining the effects of testosterone on the prostate and the efficacy and safety of exogenous testosterone in men with a history of prostate cancer. MAIN OUTCOME MEASURES Summary of effects of exogenous and endogenous testosterone on prostate tissue in vitro and in vivo, with a focus on effects in men with a history of prostate cancer. RESULTS Testosterone therapy ameliorates the symptoms of hypogonadism, decreases the risk for its negative sequelae, and can significantly improve quality of life. Recent studies do not support an increased risk for de novo prostate cancer, progression of the disease, or biochemical recurrence in hypogonadal men with a history of non-high-risk prostate cancer treated with testosterone therapy. Evidence supporting the use of testosterone in the setting of high-risk prostate cancer is less clear. CONCLUSION Despite the historical reluctance toward the use of testosterone therapy in men with a history of prostate cancer, modern evidence suggests that testosterone replacement is a safe and effective treatment option for hypogonadal men with non-high-risk prostate cancer. Additional work to definitively demonstrate the efficacy and safety of testosterone therapy in men with prostate cancer is needed, and persistent vigilance and surveillance of treated men remains necessary.
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Affiliation(s)
| | - Alexander W Pastuszak
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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19
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Kaplan AL, Hu JC, Morgentaler A, Mulhall JP, Schulman CC, Montorsi F. Testosterone Therapy in Men With Prostate Cancer. Eur Urol 2016; 69:894-903. [PMID: 26719015 PMCID: PMC5000551 DOI: 10.1016/j.eururo.2015.12.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/06/2015] [Indexed: 12/28/2022]
Abstract
CONTEXT The use of testosterone therapy in men with prostate cancer was previously contraindicated, although recent data challenge this axiom. Over the past 2 decades, there has been a dramatic paradigm shift in beliefs, attitude, and treatment of testosterone deficiency in men with prostate cancer. OBJECTIVE To summarize and analyze current literature regarding the effect of testosterone replacement in men with prostate cancer. EVIDENCE ACQUISITION We conducted a Medline search to identify all publications related to testosterone therapy in both treated and untreated prostate cancer. EVIDENCE SYNTHESIS The historical notion that increasing testosterone was responsible for prostate cancer growth was based on elegant yet limited studies from the 1940s and anecdotal case reports. Current evidence reveals that high endogenous androgen levels do not increase the risk of a prostate cancer diagnosis. Similarly, testosterone therapy in men with testosterone deficiency does not appear to increase prostate cancer risk or the likelihood of a more aggressive disease at prostate cancer diagnosis. Androgen receptor saturation (the saturation model) appears to account for this phenomenon. Men who received testosterone therapy after treatment for localized prostate cancer do not appear to suffer higher rates of recurrence or worse outcomes; although studies to date are limited. Early reports of men on active surveillance/watchful waiting treated with testosterone have not identified adverse progression events. CONCLUSIONS An improved understanding of the negative effects of testosterone deficiency on health and health-related quality of life-and the ability of testosterone therapy to mitigate these effects-has triggered a re-evaluation of the role testosterone plays in prostate cancer. An important paradigm shift has occurred within the field, in which testosterone therapy may now be regarded as a viable option for selected men with prostate cancer suffering from testosterone deficiency. PATIENT SUMMARY In this article, we review and summarize the existing literature surrounding the use of testosterone therapy in men with prostate cancer. Historically, testosterone was contraindicated in men with a history of prostate cancer. We show that this contraindication is unfounded and, with careful monitoring, its use is safe in that regard.
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Affiliation(s)
- Alan L Kaplan
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Jim C Hu
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | | | - John P Mulhall
- Sexual and Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Francesco Montorsi
- Department of Urology, Universita Vita-Salute San Raffaele, Milan, Italy
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20
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21
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Morgentaler A. Controversies and Advances With Testosterone Therapy: A 40-Year Perspective. Urology 2015; 89:27-32. [PMID: 26683750 DOI: 10.1016/j.urology.2015.11.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 11/24/2015] [Accepted: 11/30/2015] [Indexed: 11/17/2022]
Abstract
Testosterone therapy (TTh) has become highly controversial. There are important health consequences of testosterone deficiency, and meaningful benefits with treatment. There is level 1 evidence that TTh improves sexual function and desire, body composition, and bone density. Concerns regarding cardiovascular risk were based on two deeply flawed retrospective studies and are contradicted by dozens of studies showing cardiovascular benefits of TTh or higher endogenous testosterone, including placebo-controlled studies in men with known heart disease (angina, heart failure). Prostate cancer should no longer be considered a risk of TTh. Testosterone is neither scourge nor panacea--it is just good medicine.
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22
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Warburton D, Hobaugh C, Wang G, Lin H, Wang R. Testosterone replacement therapy and the risk of prostate cancer. Asian J Androl 2015; 17:878-81; discussion 880. [PMID: 25865848 PMCID: PMC4814970 DOI: 10.4103/1008-682x.150841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Understanding the role of testosterone replacement therapy (TRT) in the development and progression of prostate cancer is an important concept in treating patients with symptoms of hypogonadism. This article revealed a small number of mostly retrospective, observational studies describing the use of TRT in the general population, in men with prostatic intraepithelial neoplasia (PIN), in men with a history of treated prostate cancer, and in men on active surveillance for prostate cancer. The current literature does not report a statistically significant increase in the development or progression of prostate cancer in men receiving testosterone replacement for symptomatic hypogonadism, and the prostate saturation theory provides a model explaining the basis for these results. The use of TRT in men with a history of prostate cancer is considered experimental, but future results from randomized controlled trials could lead to a change in our current treatment approach.
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Affiliation(s)
- Daniel Warburton
- Division of Urology, University of Texas Medical School at Houston, Department of Urology, Houston, Texas, USA
| | - Christopher Hobaugh
- Division of Urology, University of Texas Medical School at Houston, Department of Urology, Houston, Texas, USA
| | - Grace Wang
- Division of Urology, University of Texas Medical School at Houston, Department of Urology, Houston, Texas, USA
| | - Haocheng Lin
- Division of Urology, University of Texas Medical School at Houston, Department of Urology, Houston, Texas, USA
| | - Run Wang
- Division of Urology, University of Texas Medical School at Houston, Department of Urology, Houston, Texas, USA
- University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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23
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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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24
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Wolff JM, Schmid HP. [Testosterone in the management of metastatic prostate cancer]. Urologe A 2015; 54:1578-83. [PMID: 26113300 DOI: 10.1007/s00120-015-3813-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Among all cancer types, prostate cancer (PCa) is the most prevalent cancer and is the third-leading cause of cancer-related death in men. The biologic function of the prostate is decisively influenced by testosterone and its metabolic product dihydrotestosterone. However, there is general uncertainty about the role of testosterone in metastatic castration-resistant prostate cancer (mCRPC). For many years, the androgen hypothesis had been accepted to explain the correlation between testosterone levels and the development or progression of PCa. However, extensive study analyses revealed contradictory results, leading to a reconsideration of the androgen hypothesis. High serum testosterone levels do not predispose to PCa development and low serum testosterone levels are not protective. The importance of testosterone levels in patients with mCRPC has been shown in several registration studies with new drugs, such as abiraterone acetate and enzalutamide. There is growing evidence suggesting a prognostic role of testosterone levels in mCRPC.
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Affiliation(s)
- J M Wolff
- Urologische Klinik, Paracelsus-Klinik Golzheim, Friederich Lau Str. 11, 40747, Düsseldorf, Deutschland.
| | - H P Schmid
- Kantonsspital St. Gallen, St. Gallen, Schweiz
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25
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Funahashi Y, Wang Z, O'Malley KJ, Tyagi P, DeFranco DB, Gingrich JR, Takahashi R, Majima T, Gotoh M, Yoshimura N. Influence of E. coli-induced prostatic inflammation on expression of androgen-responsive genes and transforming growth factor beta 1 cascade genes in rats. Prostate 2015; 75:381-9. [PMID: 25451715 PMCID: PMC4293351 DOI: 10.1002/pros.22924] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 09/26/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prostatic inflammation is reportedly associated with the development of prostatic hyperplasia. We investigated the effects of prostatic inflammation on expression levels of androgen-responsive genes and growth factors in the rat prostate. METHODS Prostatic inflammation was induced by Escherichia coli (strain 1677) injection (0.2 ml of 1 × 10(8) CFU/ml) into the prostatic urethra of male Sprague-Dawley rats, and ventral lobes of the prostate were harvested on day 84. Rats were given 10 mg/kg celecoxib during the last month in the COX-2 inhibitor treated group. Histopathology and multiplex enzyme-linked immunosorbent assay (ELISA) for inflammation-related proteins were performed. Glandular epithelial cells and stromal regions were separately isolated using laser-capture microdissection (LCM). Real-time RT-PCR was performed to examine mRNA levels of androgen-responsive genes in the epithelium and tumor growth factor-β1 (TGF-β1) cascade genes in the stroma. RESULTS Hematoxylin and eosin staining showed that mild inflammation was distributed diffusely throughout the prostate. Polymorphonuclear cells infiltrated the slightly edematous stroma, but no morphological changes were observed in the epithelium. Immunohistochemically, expression of androgen receptor and TGF-β1 in addition to IL-6 and cyclooxigenase-2 (COX-2) were enhanced in the E. coli inoculated rats. All of these factors were suppressed in the celecoxib-treated rats. Upregulation of IL-1α, IL-1β, IL-6, and RANTES in the E. coli-inoculated rats was normalized by celecoxib treatment. Significant upregulation of androgen receptor and androgen-responsive genes such as Eaf2, ELL2, FKBP5, calreticulin, and ornithine decarboxylase was observed in the LCM-dissected epithelium. Also TGF-β1 and its downstream cascade genes such as Hic-5, collagen 1, and fibronectin were upregulated significantly in the LCM-dissected stroma. The COX-2 inhibitor treatment suppressed upregulation of these genes. CONCLUSIONS Prostatic inflammation changed the expression of androgen-responsive genes in the epithelium and TGF-β1 cascade genes in the stroma. Activation of TGF-β1 cascade genes in the inflamed stroma, as well as altered androgen-responsive gene expression in the epithelium, might be involved in the development of BPH. Prostate 75:381-389, 2015. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Yasuhito Funahashi
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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26
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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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27
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Risk of disease flare with LHRH agonist therapy in men with prostate cancer: Myth or fact? Urol Oncol 2015; 33:7-15. [DOI: 10.1016/j.urolonc.2014.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 04/18/2014] [Accepted: 04/21/2014] [Indexed: 11/23/2022]
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28
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Ho CH, Jaw FS, Wu CC, Chen KC, Wang CY, Hsieh JT, Yu HJ, Liu SP. The prevalence and the risk factors of testosterone deficiency in newly diagnosed and previously known type 2 diabetic men. J Sex Med 2014; 12:389-97. [PMID: 25441980 DOI: 10.1111/jsm.12777] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION While the epidemiology of testosterone deficiency has been well described in men with previously known type 2 diabetes mellitus (T2DM), it was less reported in those with untreated, newly diagnosed T2DM. AIM The aim of this study was to investigate the prevalence and the risk factors of testosterone deficiency of men with newly diagnosed T2DM. METHODS The cross-sectional study included 105 men (mean age: 61.2 ± 6.8 years) with previously known T2DM and another 81 (57.8 ± 8.8 years) with newly diagnosed T2DM. All received health checkup and sex hormone measurement at our institute in 2009. MAIN OUTCOME MEASURES We calculated the prevalence and explored the risk factors of low total (<300 ng/dL) and free (<6 ng/dL) testosterone in men with newly diagnosed and previously known T2DM. RESULTS Men with previously known T2DM were older and had higher diastolic pressure and greater fasting glucose. There was no significant difference in total (358.0 [155.0] ng/dL vs. 363.0 [154.0] ng/dL, P=0.68) and free (7.2 [2.5] ng/dL vs. 7.4 [2.4]ng/dL, P=0.84) testosterone and sex-hormone binding globulin (SHBG) (27.3 [22.3]nmol/L vs. 28.7 [14.9]nmol/L, P=0.46). The prevalence of low total and free testosterone was 28.4% and 21.0%, respectively, in men with newly diagnosed T2DM, and was 26.7% and 19.0% in those with previously known T2DM. In men with previously known T2DM, better glycemic control (HbA1c <7%) was associated with a higher level of total testosterone and a lower risk of low total testosterone. Men with newly diagnosed and previously known T2DM shared similar risk factors of low total testosterone, including high HbA1c (≥ 7%), low SHBG (<20 nmol/L), obesity, hyperuricemia, hypertriglycemia, and metabolic syndrome. Elevated prostate-specific antigen was a protective factor of low total testosterone. However, none of these factors was associated with low free testosterone. CONCLUSIONS The prevalence and the risk factors of testosterone deficiency are similar between newly diagnosed and previously known type 2 diabetic men.
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Affiliation(s)
- Chen-Hsun Ho
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Urology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
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29
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Abstract
INTRODUCTION Late-onset hypogonadism, lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE), and prostate cancer commonly coexist in the aging male. Due to a better understanding of the physiology and impact of testosterone on benign and malignant diseases of the prostate, the view toward testosterone replacement therapy (TRT) in these individuals has changed dramatically over time. AIM This communication evaluates the effects of testosterone on benign prostatic growth and prostate cancer and reviews the evidence for TRT for men with BPE and prostate cancer. METHODS A literature review was performed with regards to TRT in men with prostate cancer as well as the effect of testosterone on the growth of benign prostate tissue and prostate cancer carcinogenesis. MAIN OUTCOME MEASURE To evaluate the evidence for an effect of testosterone on the growth of benign prostate tissue and the development of prostate cancer and TRT in men with prostate cancer. RESULTS TRT does not exacerbate LUTS. Current evidence is lacking but suggests that TRT may not increase the risk of subsequent diagnosis of prostate cancer, and is unlikely to impact recurrence or progression for men with treated prostate cancer, but longer follow-up is needed. CONCLUSIONS There is no evidence to suggest that TRT is contraindicated in men with BPE or effectively treated prostate cancer. Tan RBW, Silberstein JL, and Hellstrom WJG. Testosterone and the prostate. Sex Med Rev 2014;2:112-120.
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Affiliation(s)
- Ronny B W Tan
- Department of Urology, Tan Tock Seng Hospital, Novena, Singapore
| | | | - Wayne J G Hellstrom
- Department of Urology, Section of Andrology,Tulane University School of Medicine, New Orleans, LA, USA.
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30
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Khera M. Testosterone Replacement in Men with Treated and Untreated Prostate Cancer. Sex Med Rev 2013; 1:143-149. [DOI: 10.1002/smrj.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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31
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Atan A, Tuncel A, Yesil S, Balbay D. Serum testosterone level, testosterone replacement treatment, and prostate cancer. Adv Urol 2013; 2013:275945. [PMID: 24159331 PMCID: PMC3789297 DOI: 10.1155/2013/275945] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 08/20/2013] [Indexed: 12/02/2022] Open
Abstract
There has been an increase in the number of individuals seeking testosterone (T) replacement treatment (TRT) due to a decrease in their blood T levels. Prostate cancer (PCa) is also an important issue in the same age group. However, we, urologists, are anxious about PCa development after T treatment. This is because it has been assumed that T may cause PCa or exacerbate insidious PCa which is already present. In this paper, recent developments regarding the relationship between serum levels of sex hormone and prostate tissue, the causal relationship between T and development of PCa, the effect of TRT on the group of patients who are at high risk of developing PCa, the suitability of TRT for patients who have already been diagnosed with PCa, and the effect of TRT on serum prostate-specific antigen level are analyzed.
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Affiliation(s)
- Ali Atan
- Gazi University School of Medicine, Department of Urology, Besevler, 06125 Ankara, Turkey
| | - Altug Tuncel
- Ministry of Health, Ankara Numune Research and Training Hospital Third Department of Urology, Sihhiye, 06120 Ankara, Turkey
| | - Suleyman Yesil
- Gazi University School of Medicine, Department of Urology, Besevler, 06125 Ankara, Turkey
| | - Derya Balbay
- Sisli Memorial Hospital, Department of Urology, 34120 Istanbul, Turkey
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Khera M, Crawford D, Morales A, Salonia A, Morgentaler A. A new era of testosterone and prostate cancer: from physiology to clinical implications. Eur Urol 2013; 65:115-23. [PMID: 24011426 DOI: 10.1016/j.eururo.2013.08.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 08/07/2013] [Indexed: 01/02/2023]
Abstract
CONTEXT Decades-old beliefs regarding androgens and prostate cancer (PCa) have undergone dramatic shifts in light of modern evidence and new theoretical constructs, but considerable confusion remains on this topic, particularly with regard to the use of testosterone therapy in men with any history of PCa. OBJECTIVE To review current literature regarding the relationship of serum testosterone on PCa and in particular the effect of testosterone therapy on PCa progression and recurrence. EVIDENCE ACQUISITION A Medline search was conducted to identify all original and review articles assessing the effect of androgens on the prostate and the use of testosterone in men with a history of treated and untreated PCa. EVIDENCE SYNTHESIS Contrary to traditional teaching, high endogenous serum testosterone does not increase the risk of developing PCa, and low serum testosterone does not protect against PCa. Although limited in size and duration, current studies similarly fail to indicate any increased risk of PCa in men receiving testosterone therapy. These results indicate a finite ability of androgens to stimulate PCa growth (the saturation model). A majority of studies demonstrate an association between low serum testosterone and poor prognostic features of PCa, including high-grade disease, advanced pathologic stage, and increased risk of biochemical recurrence following radical prostatectomy. The prostate-specific antigen-to-testosterone ratio predicted PCa risk in several biopsy studies. Multiple reports of testosterone therapy in men after treatment for localized PCa have shown low or absent recurrence rates. Some men with untreated PCa have received testosterone therapy without evidence for PCa progression. CONCLUSIONS The long-held belief that PCa risk is related to high serum androgen concentrations can no longer be supported. Current evidence indicates that maximal androgen-stimulated PCa growth is achieved at relatively low serum testosterone concentrations. It may therefore be reasonable to consider testosterone therapy in selected men with PCa and symptomatic hypogonadism.
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Affiliation(s)
- Mohit Khera
- Baylor College of Medicine, Houston, TX, USA.
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Ramezani Tehrani F, Noroozzadeh M, Zahediasl S, Ghasemi A, Piryaei A, Azizi F. Prenatal testosterone exposure worsen the reproductive performance of male rat at adulthood. PLoS One 2013; 8:e71705. [PMID: 23967236 PMCID: PMC3744450 DOI: 10.1371/journal.pone.0071705] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 07/02/2013] [Indexed: 11/23/2022] Open
Abstract
The reproductive system is extremely susceptible to environmental insults, for example exogenous steroids during gestational development and differentiation. Experimental induction of androgen excess during prenatal life in female animal models reprograms their reproductive physiology, however the fetal programming of the male reproductive system by androgen excess has not been well studied. We aimed to determine the effect of prenatal exposure of two different doses of testosterone on different gestational days, on the male reproductive system using a rat model. Sixteen pregnant rats were randomly divided into two experimental groups and two control groups. Experimental group І were subcutaneously injected with 3 mg free testosterone on gestational days 16-19 and its controls received solvent for that time; experimental group П were subcutaneously injected with 20 mg free testosterone on day 20 of gestational period and its controls received solvent at the same time. The reproductive system morphology and function of 32 male offspring of these study groups were compared at days 6-30-60 of age and after puberty. The anogenital distance of the male offspring of both experimental groups had no significant differences on the different days of measurement, compared with controls. In the offspring of experimental group І, the testes weight, number of Sertoli, Spermatocyte and Spermatid cells, sperm count and motility and the serum concentration of testosterone after puberty were significantly decreased; except for reduction of sperm motility (p< 0.01), the other effects were not observed in the offspring of experimental group ІІ. In summary, our data show that prenatal exposure of male rat fetuses to excess testosterone disrupted reproductive function, an effect highly dependent on the time, duration and level of exposure. It seems that the reproductive system in individuals exposed to high levels of androgens during fetal life should be evaluated at puberty and likely to be treated.
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Affiliation(s)
- Fahimeh Ramezani Tehrani
- Reproduction Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Noroozzadeh
- Reproduction Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleh Zahediasl
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Piryaei
- Department of Biology and Anatomical Sciences, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rastrelli G, Corona G, Vignozzi L, Maseroli E, Silverii A, Monami M, Mannucci E, Forti G, Maggi M. Serum PSA as a predictor of testosterone deficiency. J Sex Med 2013; 10:2518-28. [PMID: 23859334 DOI: 10.1111/jsm.12266] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The relationship between serum prostate-specific antigen (PSA) and testosterone (T) levels is still controversial. According to the "saturation hypothesis," a significant relationship is apparent only in the low T range. AIM To verify whether, in a large sample of male subjects seeking medical care for sexual dysfunction (SD), PSA might represent a reliable marker of T levels. METHODS A consecutive series of 3,156 patients attending our unit for SD was studied. Among them, only subjects without history of prostate disease and with PSA levels<4 ng/mL (N=2,967) were analyzed. MAIN OUTCOME MEASURES Several hormonal and biochemical parameters were studied, along with structured interview on erectile dysfunction (SIEDY), ANDROTEST, and PsychoANDROTEST. RESULTS Receiver operating characteristic curve analysis for predicting severe hypogonadism (T<8 nmol/L) showed an accuracy of PSA=0.612±0.022 (P<0.0001), with the best sensitivity and specificity at PSA<0.65 ng/mL (65.2% and 55.5%, respectively). In the entire cohort, 254 subjects (8.6%) showed T<8 nmol/L and, among them, more than half (N=141, 4.8%) had PSA<0.65 ng/mL. After adjusting for age, low PSA was associated with hypogonadism-related features (i.e., delayed puberty, lower testis volume) and associated conditions, such as metabolic syndrome (hazard ratio [HR]=1.506 [1.241-1.827]; P<0.0001), type 2 diabetes (HR=2.044 [1.675-2.494]; P<0.0001), and cardiovascular diseases (HR=1.275 [1.006-1.617]; P=0.045). Furthermore, low PSA was associated with impaired sex- and sleep-related erections. The association between low PSA and hypogonadal symptoms and signs as well as with metabolic syndrome was retained even after adjusting for T levels. Sensitivity and positive predictive values of low PSA increased, whereas specificity and negative predictive value decreased as a function of age. CONCLUSIONS PSA is a marker of T concentrations and it may represent a new tool in confirming hypogonadism. The determination of PSA levels might give insights not only on the circulating levels of total T but also on its active fractions.
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Affiliation(s)
- Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Biomedical, Experimental, and Clinical Sciences, University of Florence, Florence, Italy
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Morgentaler A. Testosterone Therapy in Men With Prostate Cancer: Scientific and Ethical Considerations. J Urol 2013; 189:S26-33. [DOI: 10.1016/j.juro.2012.11.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Abraham Morgentaler
- Men's Health Boston and the Department of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Li F, Shen Z, Lu Y, Yun J, Fan Y. Serum Prostate-Specific Antigen Concentration and Hemodilution among Chinese Middle-Aged Obese Men: A Hematocrit-Based Equation for Plasma Volume Estimation Is Induced. Cancer Epidemiol Biomarkers Prev 2012; 21:1731-4. [DOI: 10.1158/1055-9965.epi-12-0589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sutcliffe S, Pakpahan R, Sokoll LJ, Elliott DJ, Nevin RL, Cersovsky SB, Walsh PC, Platz EA. Prostate-specific antigen concentration in young men: new estimates and review of the literature. BJU Int 2012; 110:1627-35. [DOI: 10.1111/j.1464-410x.2012.11111.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schwartz E, Morelli V, Holtorf K. Hormone replacement therapy in the geriatric patient: current state of the evidence and questions for the future--estrogen, progesterone, testosterone, and thyroid hormone augmentation in geriatric clinical practice: part 2. Clin Geriatr Med 2012; 27:561-75. [PMID: 22062441 DOI: 10.1016/j.cger.2011.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The data reviewed herein show that hormone replacement therapies improve some conditions associated with aging. Additionally, some of the long-held fears of significant side effects associated with hormone supplementation may be overstated, especially when providing patients with individualized care and optimal monitoring. We encourage clinicians to consider such interventions based on the evidence presented.More long-term studies are needed to further quantify and substantiate the risks and benefits associated with the use of such therapies.
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Affiliation(s)
- Erika Schwartz
- Age Management Institute, 200 West 57 Street, New York, NY 10019, USA.
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Jannini EA, Gravina GL, Morgentaler A, Mortengaler A, Morales A, Incrocci L, Hellstrom WJG. Is testosterone a friend or a foe of the prostate? J Sex Med 2011; 8:946-55. [PMID: 21457469 DOI: 10.1111/j.1743-6109.2011.02233.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Is there any unequivocal evidence that testosterone (T) can stimulate growth and aggravate symptoms in men with locally advanced and metastatic prostate cancer (PCa)? This is not a controversial point: the answer is yes. However, this evidence does not imply that PCa is a result of T or therapy with T (TTh) of hypogonadal men. Furthermore, currently adequately powered and optimally designed long-term prostate disease data are not available to determine if there is an additional risk from normal T values in cured patients for PCa. METHODS This Controversy is introduced by an endocrinologist, the section editor (E.A.J.) with G.L.G., a fellow urologist and radiotherapist expert in basic research on PCa. Two outstanding urologists, A.M and W.J.G.H., debate clinical data and clinical guidelines, respectively. Finally, other controversial issues are discussed by another leader in the field (A.M.) and a radiation oncologist and sexologist who is actually president of the International Society for Sexuality and Cancer (L.I.). MAIN OUTCOME MEASURE Expert opinion supported by the critical review of the currently available literature. RESULT The answer to the main question "is the prostate a really T-dependent tissue?" is definitively yes, but T stimulates the prostatic tissue in a dose-dependent fashion only to a saturation point, achieved at low T concentrations. At these low T concentrations, stimulation is near maximal, and T supplementation above this level would not lead to significantly greater stimulation. Furthermore, there is no conclusive evidence that TTh increases the risk of PCa or even prostatic hyperplasia. There is also no evidence that TTh will convert subclinical PCa to clinically detectable PCa. However, there is a limited clinical experience of TTh after successful treatment of PCa. So far, just 48 patients have been studied in the three published articles. CONCLUSIONS It is evident that the issue is still controversial and much more research is needed. However, the available data suggest to the expert in sexual medicine that TTh can be cautiously considered in selected hypogonadal men previously treated for curative intent of low-risk PCa and without evidence of active disease.
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Affiliation(s)
- Emmanuele A Jannini
- Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy Men's Health Boston, Harvard Medical School, Boston, MA, USA.
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Abstract
An effective, safe, reversible, and acceptable method of contraception is an important component of reproductive health and provides the opportunity of shared responsibility for family planning for both partners. Female hormonal contraceptives have been proven to be safe, reversible, available and widely acceptable by different populations. In contrast, male hormonal contraception, despite significant progress showing contraceptive efficacy comparable to female hormonal methods during last three decades, has not yet led to an approved product. Safety of a pharmaceutical product is an appropriate concern but the majority of male hormonal contraceptive clinical trials have not reported significant short term safety concerns. While the absence of serious adverse effects is encouraging, the studies have been designed for efficacy endpoints not long term safety. In this review we summarize potential risks and benefits of putative male hormonal contraceptives on reproductive and non-reproductive organs. While the review covers what we believe will be the likely class of drugs used for male hormonal contraception a true assessment of long term risks and benefits cannot be achieved without an available product.
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Affiliation(s)
- Niloufar Ilani
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA 90509, USA
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Abstract
The controversies surrounding testosterone replacement therapy (TRT) have been addressed in the past few years. Although the androgenic effects of TRT on normal and malignant prostate cells have been studied for over 70 years, little clinical prospective research exists on the physiological responses of prostate tissues to a wide range of serum testosterone levels. The prostate is both an androgen-dependent and an androgen-sensitive organ; active processes are triggered at a 'threshold' or 'saturation' level of testosterone. Despite decades of research, no compelling evidence exists that increasing testosterone beyond this threshold level has a causative role in prostate cancer, or indeed changes the biology of the prostate. Testosterone deficiency has marked physiological and clinical effects on men in middle age and beyond. With subnormal testosterone levels, the potential positive benefits of TRT on factors such as muscle mass, libido or erectile function are likely a dose-response phenomenon, and should be considered differently than the threshold influence on the prostate. This Review will re-examine classic androgen research and reflect on whether testosterone actually stimulates prostatic cellular growth and progression in a 'threshold' or a 'dose-response' (or both) manner, as well as discuss the influence of testosterone on prostate cells in the hypogonadal and eugonadal states.
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Morgentaler A, Lipshultz LI, Bennett R, Sweeney M, Avila D, Khera M. Testosterone Therapy in Men With Untreated Prostate Cancer. J Urol 2011; 185:1256-60. [DOI: 10.1016/j.juro.2010.11.084] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Abraham Morgentaler
- Men's Health Boston, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Richard Bennett
- Department of Urology, Baylor Medical College, Houston, Texas
| | - Michael Sweeney
- Men's Health Boston, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Desiderio Avila
- Department of Urology, Baylor Medical College, Houston, Texas
| | - Mohit Khera
- Department of Urology, Baylor Medical College, Houston, Texas
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Morgentaler A. Turning conventional wisdom upside-down. Cancer 2011; 117:3885-8. [DOI: 10.1002/cncr.25975] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 01/18/2011] [Indexed: 11/08/2022]
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Vyssoulis G, Karpanou E, Kyvelou SM, Vlachopoulos C, Tzamou V, Stefanadis C. Prostate-specific antigen levels are associated with arterial stiffness in essential hypertensive patients. J Sex Med 2010; 9:3205-10. [PMID: 20722777 DOI: 10.1111/j.1743-6109.2010.01979.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Prostate-specific antigen (PSA) has been recently related to cardiovascular system in a multifactorial way. Arterial stiffness is a independent predictor of cardiovascular events and is involved in the pathogenesis of hypertension. The aim of the present study was to investigate whether PSA values, are associated with arterial stiffness indices in patients with essential arterial hypertension. METHODS The study comprised 150 consecutive male patients (mean age 60 years) with uncomplicated never-treated essential hypertension. All patients underwent a complete clinical and laboratory evaluation, including measurement of PSA levels. Aortic stiffness and arterial wave reflection assessment was made by using carotid-femoral (PWVc-f) pulse wave velocity and aortic augmentation index corrected for heart rate (AIx75). Patients with prostate cancer or benign prostate hyperplasia (PSA > 4 ng/mL) were excluded from the study. RESULTS PSA was positively associated with waist-to-hip ratio (r = 0.235, P = 0.04), PWVc-f (r = 0.426, P < 0.001), AIx75 (r = 0.264, P = 0.001), and high sensitivity C-reactive protein (hsCRP; r = 0.376, P < 0.001). In categorization to PSA quartiles, patients in the higher quartile presented with higher waist-to hip ratio (P = 0.009), PWVc-f (P < 0.00001), AIx75 (P < 0.001) and hsCRP (P < 0.001) values. In multivariate analysis after adjustment for various confounders PSA remained a significant determinant of PWVc-f values (beta [SE] = 0.477 [0.13], R(2) = 0.405, P < 0.001). CONCLUSION The present study points towards an association between PSA levels and aortic stiffness in untreated essential hypertensive males. Potential causal relationships between PSA and arterial stiffness remain to be further explored.
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Affiliation(s)
- Gregory Vyssoulis
- Hypertension Unit, 1st Cardiology Clinic Athens University, Hippokration Hospital, Athens, Greece
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Abstract
Hypogonadism is a clinical and biochemical syndrome associated with a range of disease states that has significant effects on morbidity and mortality and also affects quality of life. Because of the increase in life expectancy and prostate carcinoma (PCa) survival, a significant increase in the number of men with hypogonadism who have undergone presumably curative treatment of PCa is anticipated. Despite the widespread belief regarding contraindication of testosterone administration to men with known or suspected PCa, there is no convincing evidence that the normalization of testosterone serum levels in men with low levels presents a deleterious effect on the evolution of the disease. In the few available case series describing testosterone replacement therapy (TRT) after treatment of PCa, no case of clinical or biochemical progression was observed. The available data suggest that TRT can be cautiously considered in selected hypogonadal men previously treated for curative intent of low-risk PCa and without evidence of active disease.
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Glina S, Rivero MA, Morales A, Morgentaler A. Classic Citations: Studies on Prostatic Cancer I. The Effect of Castration, of Estrogen and of Androgen Injection on Serum Phosphatases in Metastatic Carcinoma of the Prostate* by Charles Huggins and Clarence V. Hodges. J Sex Med 2010; 7:640-4. [DOI: 10.1111/j.1743-6109.2009.01680.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rhoden EL, Averbeck MA. [Prostate carcinoma and testosterone: risks and controversies]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2009; 53:956-962. [PMID: 20126847 DOI: 10.1590/s0004-27302009000800008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 10/31/2009] [Indexed: 05/28/2023]
Abstract
Hypogonadism is a clinical and biochemical syndrome which may cause significant detriment in the quality of life. With the increase in life expectancy and prostate cancer survival a significant increase in the number of men with hypogonadism who have undergone presumably curative treatment for PCa is anticipated. Despite the widespread contraindication of testosterone in men with known or suspected prostate cancer, there is no convincing evidence that the normalization of testosterone serum levels in men with low, but not castrate levels, is deleterious. Although further studies are necessary before definitive conclusions can be drawn, the available evidence suggests that testosterone replacement therapy can be cautiously considered in selected hypogonadal men treated with curative intent for low risk prostate cancer and without evidence of active disease.
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Affiliation(s)
- Ernani Luis Rhoden
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brasília, DF, Brasil.
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Isbarn H, Pinthus JH, Marks LS, Montorsi F, Morales A, Morgentaler A, Schulman C. Testosterone and Prostate Cancer: Revisiting Old Paradigms. Eur Urol 2009; 56:48-56. [DOI: 10.1016/j.eururo.2009.03.088] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/26/2009] [Indexed: 11/16/2022]
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Morgentaler A. Testosterone Therapy in Men With Prostate Cancer: Scientific and Ethical Considerations. J Urol 2009; 181:972-9. [PMID: 19150547 DOI: 10.1016/j.juro.2008.11.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Abraham Morgentaler
- Men's Health Boston and the Department of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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