HealingWell
Search Close Search
☰

What is the actual impact of testosterone on PCa?

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 11/22/2015 3:30 PM (GMT 0)
Many of us have heard that testosterone can act like jet fuel for PCa. Specifically, that taking something like Androgel can accelerate PCa rapidly. I have seen a lot of generic comments on this topic, but the actual research of the effects of testosterone on PCa seems dated and a bit thin. Has there actually been any recent studies done on this topic? There are a lot of men out there that can benefit from T therapy. Is PCa really an instant "deal killer" for T therapy?
Posted 11/22/2015 4:44 PM (GMT 0)
I've been taking TRT for 3 years now, my psa has never changed. I took it to reverse osteopenia from low T and now my bone scans are normal. I would be more concerned of TRT raising your risk of heart attacks and stroke which some studies now show. I recently cut back my testosterone dose to achieve low but normal levels.
Posted 11/22/2015 5:44 PM (GMT 0)
There is a sort of received wisdom going on here. There are clues, and statistical models, and stuff like that. And we wind up going from A to B, maybe without there really being a linkage.

We know, for example (see the thread below about why do we use ADT?) that prostate cell growth is dependent on testosterone. Without testosterone, prostate cells die. We also know, that PC cells are a mutated version of normal prostate cells. Additionally, there is some evidence out there that men who megadose steroids do seem to have a statistically higher PC risk. Add those up, and we get this idea. Right or wrong? That answer is still out there, because we still aren't sure what it is that turns a 'normal' cell into a 'cancer' cell. There are enticing clues out there. I like the 'dna replication error model', which basically says that every time cell division happens, there is a reasonable statistical probability of some sort of dna transcription error. 99.99% of those errors are either harmless, or immediately cause the death of the daughter cell. That other fractional % gives rise to a cancer cell.

All that being said, and a bit of a wander from the OP question, we have what might be a more important question for those of us who no longer have prostates...or who have cooked them into submission...what is OUR risk of taking testosterone supplements? Evidence suggests that it's not a problem. Most medical people have yet to embrace that idea.
Posted 11/22/2015 6:28 PM (GMT 0)
It is important to understand that treating men with artificial (exogenous) testosterone results in a reduction of netural(endogenous) testosterone. Therefore it is always preferable to aument the natural production of testosterone first. That is not easily done and practitioners resort on supplying exogenous testosterone. This is no problem in healthy men who suffer from low levels of natural testosterone. Treating prostate cancer patients with testosterone supplementation after treatment is relatively new and currently being safely done more and more.
In such patients if the cancer is still present close monitoring of PSA is reasonable if there is a benefit to quality of life.

It is well established the biphasic nature of the androgen testosterone. This means that supplying or depriving testosterone in a patient it can promote or reduce PCa growth. That was the basis for the Bipolar androgen therapy trial(BAT) as described here:

" Preclinical data supported a pilot study in which 16 asymptomatic CRPC patients with low to moderate metastatic burden were treated with testosterone cypionate (400 mg intramuscular; day 1 of 28) and etoposide (100 mg oral daily; days 1 to 14 of 28). After three cycles, those with a declining prostate-specific antigen (PSA) continued on intermittent testosterone therapy monotherapy. Castrating therapy was continued to suppress endogenous testosterone production, allowing for rapid cycling from supraphysiologic to near-castrate serum testosterone levels, a strategy termed bipolar androgen therapy (BAT). BAT was well tolerated and resulted in high rates of PSA (7 of 14 evaluable patients) and radiographic responses (5 of 10 evaluable patients). Although all men showed eventual PSA progression, four men remained on BAT for ≥1 year. All patients (10 of 10) demonstrated PSA reductions upon receiving androgen-ablative therapies after BAT, suggesting that BAT may also restore sensitivity to ADTs. BAT shows promise as treatment for CRPC and should be further evaluated in larger trials."

As you can see, BAT is an option to not only improve QOL but also potentially extend survival. More trials will be needed but there is potential in promoting more research to benefit patients who progress after treatment.

Response to TRT in advanced PCa is a complex issue involving a multitude of receptors present in individual patients that can activate tumor suppressors or promoters in those patients. Therefore TRT is not beneficial to all those patients. Caution required.

Source:
Schweizer MT, Antonarakis ES, Wang H, Ajiboye AS, Spitz A, Cao H, Luo J, Haffner MC, Yegnasubramanian S, Carducci MA, Eisenberger MA, Isaacs JT, Denmeade SR. Effect of bipolar androgen therapy for asymptomatic men with castration-resistant prostate cancer: results from a pilot clinical study. Sci Transl Med. 2015 Jan 7;7(269):269ra2. doi: 10.1126/scitranslmed.3010563. PubMed
PMID: 25568070; PubMed Central PMCID: PMC4507510.

RalphV
Posted 11/22/2015 7:07 PM (GMT 0)
There have been many studies indicating its safety after definitive therapy, but they are all database studies like this one:

Testosterone Replacement Therapy Following the Diagnosis of Prostate Cancer: Outcomes and Utilization Trends

or, small retrospective charts reviews like these:

Testosterone Replacement Therapy in Patients with Prostate Cancer After Radical Prostatectomy
Testosterone replacement therapy after radiation therapy

or small, single-arm prospective studies like this one:

Testosterone Replacement Therapy Following Radical Prostatectomy

There was even one in men who were on active surveillance with untreated prostate cancer:

Can testosterone therapy be offered to men on active surveillance for prostate cancer? Preliminary results

What we lack is a large scale randomized prospective clinical trial. In such a trial, men who have low T levels after their PC treatment would be randomized to T replacement or placebo. Until we have a definitive study like that, we can't say it's safe with certainty, although it certainly appears to be safe so far. In my experience, most urologists are willing to give it, but watch patients closely.

- Allen
✚ New Topic ✚ Reply