Magazine article Drug Topics

New Data on Testosterone Debunk Prostate Link

Magazine article Drug Topics

New Data on Testosterone Debunk Prostate Link

Article excerpt

The major concern with TRT is "the risk of increased prostate cancer," E. David Crawford, M.D., professor of surgery (urology) and radiation oncology at the University of Colorado Health Sciences Center, Denver, told the recent Urology Congress in San Francisco. But "there are no data to support testosterone substitution as a cause of prostate cancer."

The original association between increased testosterone levek and increased prostate cancer risk was based upon equivocal results in a single patient in 1941, Crawford noted. Data reported over the intervening decades show about a 1% rate of prostate cancer in men on TRT-similar to the rate found by routine screening of the general male population.

Falling rates of testosterone and higher rates of prostate cancer are both associated with increasing age, Crawford said. That raises the possibility that TRT could protect against prostate cancer, but there are no data.

Trials of TRT following radical prostatectomy show no associated increase in prostate-specific antigen (PSA) levels. At the same time, men who receive TRT after prostatectomy show all the familiar benefits: improved muscle mass and strength, less central fat, improved cognition, improved mood, better physical performance, fewer fractures, increased sexual interest, improved erectile function, and better quality of life. "TRT is safe with appropriate medical monitoring." Crawford recommends quarterly PSA monitoring and digital rectal exams for the first year of TRT and every six months thereafter.

Another surprise was the announcement that finasteride reduces the risk of prostate cancer by 25% with no change in the risk for high-grade tumors. Initial reports from the Prostate Cancer Prevention Trial indicated that while finasteride reduced prostate cancer by 25%, it also produced a 25% increase in high-grade tumors. Later analysis showed that the jump in high-grade tumors was linked to finasteride's ability to shrink an enlarged prostate by 25%.

"If you do the same number of biopsies in a smaller gland as in an enlarged gland, it stands to reason that you will find more cancers," explained Eric Klein, M.D., professor of surgery at the Cleveland Clinic Lerner College of Medicine of case Western Reserve University. …

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