In the treatment of prostate cancer patients, multiple studies and multiple researchers have shown that testosterone therapy does not increase the risk of prostate cancer.  Men with testosterone deficiency treated with testosterone therapy, have a decreased risk of developing prostate cancer.  Men on testosterone replacement, also develop less aggressive cancers!

In prostate cancer patients, who opt for testosterone replacement, there is an apparent lack of cancer  progression.  In a study of 149,354 patients with prostate cancer, 1181 chose to use testosterone therapy.  There was no increase in overall mortality or cancer specific mortality in the testosterone therapy group.

In patients, who have undergone radical prostatectomy for low and intermediate risk prostate cancer, testosterone therapy has not been shown to cause biochemical recurrence (increase in PSA) by multiple researchers.  Dr. Pastuszak, in 2013, published a similar study but his patient population included 25% with high risk disease.  There were more recurrences in the group not on testosterone therapy.

A multi-institutional study performed on men who received radiation treatment for prostate cancer, looked at recurrence of prostate cancer in men receiving testosterone.  76% of men in the study had low or intermediate risk prostate cancer, 6% had a biochemical recurrence.  The recurrence rate was less than expected for radiation therapy patients.

There are some patients with low risk prostate cancer who choose not to begin treatment but to be followed closely with “active surveillance.”  A low free testosterone was an independent predictor of prostate cancer progression.

Some patients, unfortunately, fail radical prostatectomy and radiation therapy and develop metastatic disease.  Dr. Bob Leibovitz is using high dose testosterone therapy to treat men with testosterone deficiency.  43% of these patients have had progression but what is so amazing,57% have not!

It may be time to enter our zone of discomfort and allow research rather than fear, direct medical management.

The use of synthetic testosterone by injection, if used appropriately ( for testosterone deficiency, in the right dose, and in the correct dosing interval) has not been shown to increase the risk of prostate cancer.  However, many men are now obtaining vials of testosterone in the mail and then using doses much higher than prescribed, as well as injecting way too frequently.  There is a theoretical concern that chronic supraphysiologic levels of testosterone may lead to chronic supraphysiologic levels of estradiol as testosterone converts to estradiol.  Will future research reveal that abuse/overuse increases risk of prostate cancer?  Testosterone replacement in the form of bioidentical testosterone pellets, leads to steady state, physiological levels of testosterone (not supraphysiologic ), that last for 4-6 months!  Bioidentical testosterone has the exact same chemical structure and 3D shape as the testosterone we produce naturally. Research has shown that the best way to deliver bioidentical hormones to the body, is in the form of subcutaneous pellets.  It is also the best method for symptom relief.

References:

The New Testosterone Treatment:  How You and Your Doctor Can Fight Breast Cancer, Prostate Cancer, and Alzheimer’s.  Dr. Edward Friedman, 2013

“Testosterone Therapy in Men With Prostate Cancer”  A. Kaplan et al., European Urology, 2015

“Turning conventional wisdom upside-down* Low serum testosterone and high-risk prostate cancer”.  A. Morgentaler, Cancer, 3/2011

“Testosterone replacement therapy following the diagnosis of prostate cancer:  outcomes and utilization trends”  Sexual Medicine, 2014

“The Estradiol-Dihydrotestosterone model of prostate cancer” E. Friedman, Theoretical Biology and Medical Modelling, 2005

“Testosterone replacement in prostate cancer survivors with hypoganadal symptoms”. R. Leibovitz, British Journal of Urology, 2010

“Testosterone Therapy in Men With Prostate Cancer”. A. Kaplan, European Urology, 2015

“Testosterone therapy after radiation therapy for low, intermediate, and high risk prostate cancer”, A. Pastuszak, Urology, 2015

“Low free testosterone levels predict disease reclassification in men with prostate cancer undergoing active surveillance” I. San Francisco, British Journal of Urology, 2014

Dr. Cross recently retired from Scripps Clinic in San Diego.  She is board certified in Obstetrics and Gynecology and has specialized in Bioidentical hormone replacement for 22 years.  Relocating to Citrus County to spend more time with family, she presently lives with her husband James, in Pine Ridge.  Dr. Cross and is the Medical Director of Hormone Therapy of Citrus County as well as Medical Director of Hormone Therapy Centers of America.  She offers hormone pellet therapy to both women and men.