Zusammenfassung
Ab dem 40. Lebensjahr kommt es beim Mann zu einem kontinuierlichen Abfall des Gesamttestosteronspiegels. Treten zu einem erniedrigten Testosteronspiegel Symptome wie Abgeschlagenheit, abnehmende Libido oder Osteoporose hinzu, spricht man von einem Altershypogonadismus (LOH, late onset hypogonadism) oder partiellem Androgendefizit des alternden Mannes (PADAM). Dieses wird durch die Hormonersatztherapie mit Testosteron behandelt. Zuvor muss ein Prostatakarzinom ausgeschlossen werden, da diese androgenabhängig wachsen. Die Frage ist nun, wie man sich bei Patienten verhält, die an einem Altershypogonadismus leiden, in ihrer Anamnese aber ein kurativ behandeltes Prostatakarzinom aufweisen? Hierzu existieren nur wenige Studien mit kleinen Fallzahlen, die bisher zeigen konnten, dass bei kurativ behandelten Patienten durchaus eine Hormonersatztherapie durchgeführt werden kann, ohne dass sich das Risiko für ein Rezidiv erhöhte. Dies gilt sowohl für die vorausgegangene radikale Prostatektomie als auch für die Brachytherapie. Zwingend notwendig sind aber die gute Aufklärung und die engmaschige Überwachung des Patienten unter der Testosteronsubstitutionstherapie.
Abstract
During the male 40s total testosterone levels decrease continuously. If clinical symptoms like decreasing libido, erectile dysfunction, osteoporosis, altered distribution of body fat, reduction in physical strength, or alterations in psychological mood are combined with a decreased serum testosterone level late-onset hypogonadism (LOH) is obvious. Before the substitution of testosterone is initiated, it is essential to exclude prostate cancer because the progress of prostate cancer depends on androgens. The question is now how to treat patients who suffer from androgen deficiency but have cured prostate cancer in their history? Concerning this there are only a few studies with a small number of patients which show that testosterone substitution therapy is possible without an increased risk for recurrence of prostate cancer. As long as the patient was cured it does not matter if he underwent a radical prostatectomy or brachytherapy. Absolutely necessary is that the patient is well informed about the therapy and regularly controlled during the therapy.
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Kaminsky, A., Sperling, H. Testosteronsubstitutionstherapie beim Prostatakarzinom. Urologe 49, 20–25 (2010). https://doi.org/10.1007/s00120-009-2194-y
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DOI: https://doi.org/10.1007/s00120-009-2194-y