Originally Posted by
J. Keith Nichols MD
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So what does the modern data show us?
1. In hypogonadal men testosterone therapy does not increase the risk of developing prostate cancer even in high-risk individuals. It may in fact have a protective role against high-grade cancer and Studies have shown that higher levels of testosterone can suppress prostate cancer growth. There is an inverted U with regard to prostate cancer cell proliferation and testosterone levels. At low Testosterone levels there is suppression of prostate cancer cell proliferation, between castrate levels and the saturation level (hypogonadal) there is growth, and with high levels of testosterone there is once again suppression of prostate cancer cell proliferation. The unfortunate reality is that about 1 in 6 men have prostate cancer and if you are in a clinic and you're seeing at least 60 patients then you are most likely treating at least 10 men with active prostate cancer. So all of these clinics are in effect treating men on active surveillance with prostate cancer without any detrimental effects.
2. Testosterone therapy does not increase the risk of progression in men on active surveillance
3. Testosterone therapy does not increase the risk of biochemical recurrence after treatment of prostate cancer by radiation therapy or radical prostatectomy. Some studies have shown decreased recurrence rates in men on testosterone therapy.
Multiple studies have revealed that low testosterone is associated with
1. Higher grades of cancer
2. A more advanced stage of cancer at surgery
3. A increased rate of recurrence after surgery
4. Decreased survival
It is not high testosterone levels that are associated with poor prognostic factors but it appears to be low testosterone levels.
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