I would like to take a few moments to talk with you about a controversial topic, and that is the use of testosterone in men with prostate cancer. I would like to mention at the onset of this presentation that this is my opinion and each person, who is considering using testosterone if they have a diagnosis of prostate cancer, should discuss this in great detail with his urologist. In this article, I’m going to discuss hypogonadism, talk about the symptoms of decrease testosterone or hypogonadism, and then I will talk about the relationship of testosterone in men with prostate cancer, and what men I believe are candidates for receiving hormone replacement therapy.
Let’s begin with the definition of hypogonadism or decreased serum testosterone levels. Testosterone is a hormone that is produced in the testicles and is responsible for the sex drive and the male secondary sex characteristics such as beard, the depth of the voice, and the distribution of the muscle mass in men. Serum testosterone levels begin to decline around the age of 20 to 25 at about one percent per year. After the age of 50, significant numbers of men have decreased serum testosterone levels and symptoms of a decreased serum testosterone level, which is referred to diagnostically as hypogonadism.
Let’s now look at the symptoms of decreased testosterone. There is a diminished libido or sex drive; there can be decrease in the erections and also in the rigidity of erections adequate for sexual intimacy. There can be reduced facial hair. Men who have decreased testosterone often report a loss of energy and lethargy, and frequently these men complain falling asleep after meals, particularly after the dinner meal. Men with hypogonadism have reduced muscle power and stamina; they also have a loss of height because of the decrease in bone mineral density of the spinal cord or the spinal vertebrae that make up the spinal column. As a result, some men, who have decreased serum testosterone level, have brittle bones or a condition called osteoporosis.
Now hypogonadism or decreased testosterone is so easily diagnosed because it is simply on the basis of the symptoms and a blood test called a serum testosterone level. The serum testosterone level should be obtained in the morning because that is the time of day when testosterone is at its highest.
Now let’s look at the relationship between prostate cancer and testosterone. In the 1940s there was an identification that a reduction of the serum testosterone level either by removing the testicles or the use of female hormone estrogen in men with prostate cancer seem to have a significant impact on the metastasis or spread of cock prostate cancer to the bones. So there was a concern that is increasing the levels of testosterone levels can cause an increase of any latent prostate cancers. But a study from Harvard University by Dr. Abraham Morgentaler pointed out that there were no relations between prostate cancer and high levels of testosterone. There are studies now that showed that there is no difference in prostate cancer incidence among men, who use testosterone therapy, compared to men in the general population.
For many many years, men with prostate cancer were told to avoid taking supplemental testosterone as it could add fuel to the fire of existing cancer. It is almost as if the comparison would be women, who have breast cancer, are told to avoid the use of estrogens even if they are menopausal or postmenopausal. However, after a radical prostatectomy or removal of the prostate gland for cancer, or after treatment with radiotherapy and the PSA remains at an undetectable level after the surgery or stable after radiation therapy for at least 12 to 24 months, then these men may be candidates for hormone replacement therapy.
So a man should be considered a candidate for replacement with testosterone if the PSA remains at a low or stable level and the man has symptoms of hypogonadism that I previously discussed and has a decrease in the serum testosterone level.
Now there are precautions for men who decide to take testosterone with a diagnosis of treated prostate cancer. These men need to come back and get on a regular basis probably every other month would be the minimum, a PSA test, and the digital rectal exam if they were treated with radiation therapy. If the PSA rises, then it is necessary, in my opinion, that the supplemental testosterone be stopped.
So in summary, testosterone deficiency is a common condition in middle-aged and older men. The diagnosis is so easily made with a blood test called a serum testosterone level. And I believe based on the current evidence that certain men with prostate cancer, who have symptoms of hypogonadism and have documented low testosterone levels, may be candidates for hormone replacement therapy. However, it is necessary that these men understand that they must monitor their PSAs closely. I hope this article has been helpful for you to help make a decision regarding the use of testosterone in men with treated prostate cancer.