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Testosterone Therapy and Prostate Cancer

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Abstract

While the benefits of testosterone therapy are well documented with regard to the clinical signs and symptoms of testosterone deficiency, there is still a fear among the medical community that testosterone therapy could be a stimulus for the emergence of prostate cancer (PCa) or promote its progression. However, the evidence shows that testosterone(T) appears to have limited stimulatory effects on the prostate. Several studies suggest that testosterone stimulates the growth of prostatic neoplasia only at very low concentrations, and variations in the endogenous testosterone levels within the physiological range or above do not appear to influence prostate growth or function, as measured by markers such as prostate-specific antigen. The recognition of the finite ability of androgens to stimulate prostate growth, called the saturation model, has led to important changes in medical practice, especially with regard to consideration of testosterone therapy for men with a history of prostate cancer. Recent clinical experiences in men with PCa have suggested that T therapy is not as risky as once believed. Studies regarding testosterone administration in hypogonadal men after PCa treatment have shown no evidence of worse oncologic prognosis. Even in patients in active surveillance protocols, testosterone has been administrated with no modification of oncological outcomes, suggesting that T therapy is safe when correctly indicated and strictly monitored.

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Abbreviations

DHT:

Dihydrotestosterone

EBRT:

External beam radiation therapy

LH:

Luteinizing hormone

LHRH:

Luteinizing hormone-releasing hormone

PCa:

Prostate cancer

PCPT:

Prostate cancer prevention trial

PSA:

Prostate-specific antigen

RP:

Radical prostatectomy

SEER:

Surveillance, epidemiology, and end results

T:

Testosterone

TD:

Testosterone deficiency

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Authors and Affiliations

  1. Urology at Universidade Federal de Ciências Médicas de Porto Alegre (UFCSPA), Urology Service at Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Moinhos de Vento Hospital (HMV), Porto Alegre, Brazil

    Ernani Luis Rhoden

  2. Urology Division at Santa Casa de Misericórdia Hospital and Moinhos de Vento Hospital (HMV), Porto Alegre, Brazil

    Daniel de Freitas G. Soares

  3. Uro-oncology Department of Brazilian Urology Society, Porto Alegre, Brazil

    Daniel de Freitas G. Soares

  4. Surgery (Urology), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Abraham Morgentaler

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  1. Ernani Luis Rhoden
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  2. Daniel de Freitas G. Soares
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  3. Abraham Morgentaler
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Correspondence to Ernani Luis Rhoden .

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Editors and Affiliations

  1. Department of Internal Medicine - Division of Endocrinology and Metabolism, Universidade Federal de Santa Catarina, Florianopolis, Santa Catarina, Brazil

    Alexandre Hohl

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Rhoden, E.L., Soares, D.d.F.G., Morgentaler, A. (2023). Testosterone Therapy and Prostate Cancer. In: Hohl, A. (eds) Testosterone. Springer, Cham. https://doi.org/10.1007/978-3-031-31501-5_18

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  • DOI: https://doi.org/10.1007/978-3-031-31501-5_18

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