Testosterone replacement therapy and prostate cancer

Testosterone replacement therapy and prostate cancer

With a lack of male sex hormone testosterone that can be replaced by medication.This treatment does not appear to increase the risk for the occurrence and recurrence of prostate cancer.

Testosterone is produced mainly in the testicles and is the main representative of the male sex hormones, the androgens . They are important for the development and many features of the male body, not just for the sexual function such as libido ("Lust"), erection (link stiffening) and fertility, but also for the muscles, hair, metabolism, blood formation, the psyche and much more (see sex hormones ).

A lack of testosterone is called hypogonadism (underactive sex glands). It can be congenital or acquired and have numerous causes. The symptoms (signs of disease) depend on the time of occurrence and the extent of the defect. Of hypogonadism occurs, for example before puberty, remains from this and thus the progression to man (eunuchoidism of eunuch, castrato).Another example is the lack of testosterone by a medical androgen deprivation in prostate cancer with its typical potential side effects (see hormone therapy for prostate cancer ).

A common acquired form is the so-called late-onset hypogonadism. There are many names such as PADAM (partial androgen deficiency of the aging male), ADAM (Androgenmangelsyndrom), TMS (Testosterone Deficiency Syndrome), andropause (androgen-break), menopause and LOH (English late onset hypogonadism virile (male menopause) = Late Onset hypogonadism). Its incidence increases with age, from 10% at 40-year-olds to 30% for 80-year-olds, because the testosterone production from about the 40thAge is getting low (about 1% per year). Also in "lifestyle diseases" such as obesity, dyslipidemia, and diabetes mellitus (sugar diabetes) occurs before onset hypogonadism frequently.

However, no symptoms have (symptoms) occur. Such are, for example, the breakdown of muscle (weakness) and bone (osteoporosis, bone pain), redistribution of body fat, weight gain, hot flashes, fatigue, depression, loss of libido ("Lust") and erectile dysfunction (impaired limb stiffening). Many of them, however, can also be caused by age or an unhealthy lifestyle (eg, lack of exercise, diet, alcohol consumption, smoking). Therefore, here, as with other forms of hypogonadism detailed investigations are necessary before the diagnosis is made ​​and therapy is initiated.

The treatment of hypogonadism is medically possible. For this, there are numerous testosterone preparations in various shapes available (syringes, capsules, patches, gel). In this case, a replacement takes place (substitution) of the lack of testosterone, so that normalized the blood levels. Especially in men in middle and older age, however, the question arises whether the testosterone replacement therapy increases the risk of developing prostate cancer or its recurrence (relapse) after a previous successful cancer treatment. Because androgens known to play an important role in the growth of prostate cancer, and their withdrawal is one of the treatment options (see causes or hormonal therapy of prostate cancer).

Testosterone replacement and prostate cancer risk
From the height of the blood level of testosterone can not conclude on the risk of the presence of prostate cancer you. However, the risk for the development of prostate cancer increases with the amount of free testosterone present in the blood, but which decreases with age. The testosterone replacement therapy could promote the growth of prostate cancer and is contraindicated ("forbidden"), if such a tumor is present. In hypogonadal men with prostate cancer should therefore means before starting treatment DRE (digital rectal examination) and determination of PSA -value are excluded.

There is no prostate cancer, testosterone can be replaced in men with hypogonadism medication. The fact that this increases the risk of developing prostate cancer, has not been demonstrated. However, this still lack long-term data. During the testosterone replacement therapy should in the first year and every six months thereafter, a DRU and a control of the PSA value, the testosterone level and the annual hematocrit done ("thickness" of the blood).

Hormone replacement after Prostate Cancer Treatment
Men with prostate cancer whose tumor curative (healing) was treated (by radical prostatectomy or radiation therapy), may develop hypogonadism after this treatment. With testosterone replacement therapy can reduce its risks and significantly improve the symptoms and thus the quality of life of those affected. Whether by increasing the risk for a relapse (recurrence of the tumor), is still unclear. Therefore, the defendant should be exactly solved and should be closely monitored (checks every 3-6 months). In preliminary studies with a start of replacement therapy at the earliest after 2 years, no increased risk of recurrence was found. The drugs in these cases have not yet approved.
About men with prostate cancer who suffer from hypogonadism, but were not, or not yet treated curatively, there are only a few reports on testosterone replacement therapy, so no recommendation is possible. This applies especially to patients after discontinuation of hormone therapy, in which testosterone production does not rise again, but also patients with metastases (secondary tumors) and men under active surveillance.

Conclusion
The testosterone replacement therapy does not appear to increase the risk for the emergence and recurrence of prostate cancer. However, it is not advisable from an uncritical and uncontrolled use, especially if this is done with the aim to try to stop the natural aging process (anti-aging). Especially with symptoms such as obesity, dyslipidemia and diabetes mellitus, which can be both a cause and a consequence of a testosterone deficiency, as well as characters such as sexual dysfunction that may result from an unhealthy lifestyle, you should first try to change the lifestyle, for example, with a healthy diet and increased physical activity or sport.