Is There A Protective Role Of Testosterone Against Prostate Cancer?

[Michael Scally MD]

Yassin A, Salman M, Talib RA, Yassin DJ. Is there a protective role of testosterone against high-grade prostate cancer? Incidence and severity of prostate cancer in 553 patients who underwent prostate biopsy: a prospective data register. Aging Male. http://www.tandfonline.com/doi/abs/10.1080/13685538.2017.1298584?journalCode=itam20

This study investigated the role of testosterone replacement therapy (TRT) in prostate safety and cancer progression.

A cohort of 553 patients, 42 treated and 162 untreated hypogonadal men, and 349 eugonadal men were included.

Pathological analysis of prostate biopsies examining the incidence and severity of PCa revealed that:

• 16.7% of treated hypogonadal men had a positive biopsy, a Gleason score of </=6 in 71.4% and >6 in 28.6% of men, a predominant score of 3 and tumour staging of II in 85.7% men;
• 51.9% of untreated hypogonadal men had a positive biopsy, a Gleason score of </=6 in 40.5% and >6 in 59.5% men, a predominant score of 3 (77.4%) and tumour staging of II (41.7%) or III (40.5%);
• 37.8% of eugonadal men had a positive biopsy, a Gleason score of </=6 in 42.4% and >6 in 57.6% of men, a predominant score of 3 (82.6%) and tumour staging of II (44.7%) or III (47.7%).

The incidence of positive prostate biopsies was lowest in hypogonadal men receiving TRT, with significantly lower severity of PCa in terms of staging and grading in the same group.

These results suggest that TRT might have a protective effect against high-grade PCa.

 

[Michael Scally MD]

[PATIENTS WHO RECEIVED TRT HAD MORE FAVORABLE-RISK PROSTATE CANCER AND A LOWER RISK OF AGGRESSIVE PROSTATE CANCER.]

[OA] Loeb S, Folkvaljon Y, Damber JE, et al. Testosterone replacement therapy and risk of favorable and aggressive prostate cancer. J Clin Oncol. 2017. http://ascopubs.org/doi/full/10.1200/JCO.2016.69.5304

Purpose - The association between exposure to testosterone replacement therapy (TRT) and prostate cancer risk is controversial. The objective was to examine this association through nationwide, population-based registry data.

Methods - We performed a nested case-control study in the National Prostate Cancer Register of Sweden, which includes all 38,570 prostate cancer cases diagnosed from 2009 to 2012, and 192,838 age-matched men free of prostate cancer. Multivariable conditional logistic regression was used to examine associations between TRT and risk of prostate cancer (overall, favorable, and aggressive).

Results - Two hundred eighty-four patients with prostate cancer (1%) and 1,378 control cases (1%) filled prescriptions for TRT.

In multivariable analysis, no association was found between TRT and overall prostate cancer risk (odds ratio [OR], 1.03; 95% CI, 0.90 to 1.17).

HOWEVER, PATIENTS WHO RECEIVED TRT HAD MORE FAVORABLE-RISK PROSTATE CANCER (OR, 1.35; 95% CI, 1.16 TO 1.56) AND A LOWER RISK OF AGGRESSIVE PROSTATE CANCER (OR, 0.50; 95% CI, 0.37 to 0.67).

The increase in favorable-risk prostate cancer was already observed within the first year of TRT (OR, 1.61; 95% CI, 1.10 to 2.34), whereas the lower risk of aggressive disease was observed after > 1 year of TRT (OR, 0.44; 95% CI, 0.32 to 0.61).

After adjusting for previous biopsy findings as an indicator of diagnostic activity, TRT remained significantly associated with more favorable-risk prostate cancer and lower risk of aggressive prostate cancer.

Conclusion - The early increase in favorable-risk prostate cancer among patients who received TRT suggests a detection bias, whereas the decrease in risk of aggressive prostate cancer is a novel finding that warrants further investigation.

 

[ddp7]

[PATIENTS WHO RECEIVED TRT HAD MORE FAVORABLE-RISK PROSTATE CANCER AND A LOWER RISK OF AGGRESSIVE PROSTATE CANCER.]

[OA] Loeb S, Folkvaljon Y, Damber JE, et al. Testosterone replacement therapy and risk of favorable and aggressive prostate cancer. J Clin Oncol. 2017. http://ascopubs.org/doi/full/10.1200/JCO.2016.69.5304

Purpose - The association between exposure to testosterone replacement therapy (TRT) and prostate cancer risk is controversial. The objective was to examine this association through nationwide, population-based registry data.

Methods - We performed a nested case-control study in the National Prostate Cancer Register of Sweden, which includes all 38,570 prostate cancer cases diagnosed from 2009 to 2012, and 192,838 age-matched men free of prostate cancer. Multivariable conditional logistic regression was used to examine associations between TRT and risk of prostate cancer (overall, favorable, and aggressive).

Results - Two hundred eighty-four patients with prostate cancer (1%) and 1,378 control cases (1%) filled prescriptions for TRT.

In multivariable analysis, no association was found between TRT and overall prostate cancer risk (odds ratio [OR], 1.03; 95% CI, 0.90 to 1.17).

HOWEVER, PATIENTS WHO RECEIVED TRT HAD MORE FAVORABLE-RISK PROSTATE CANCER (OR, 1.35; 95% CI, 1.16 TO 1.56) AND A LOWER RISK OF AGGRESSIVE PROSTATE CANCER (OR, 0.50; 95% CI, 0.37 to 0.67).

The increase in favorable-risk prostate cancer was already observed within the first year of TRT (OR, 1.61; 95% CI, 1.10 to 2.34), whereas the lower risk of aggressive disease was observed after > 1 year of TRT (OR, 0.44; 95% CI, 0.32 to 0.61).

After adjusting for previous biopsy findings as an indicator of diagnostic activity, TRT remained significantly associated with more favorable-risk prostate cancer and lower risk of aggressive prostate cancer.

Conclusion - The early increase in favorable-risk prostate cancer among patients who received TRT suggests a detection bias, whereas the decrease in risk of aggressive prostate cancer is a novel finding that warrants further investigation.

Bottom line: small testicles induced by trt implies less masturbation?
Dont got it

 

[Michael Scally MD]

Re: Testosterone Replacement Therapy and Risk of Favorable and Aggressive Prostate Cancer

Patients constantly present to my office asking if they are at increased risk for prostate cancer if they take testosterone replacement therapy (TRT). We know that in the laboratory prostate cancer growth is accelerated by testosterone, so it would follow that there might be a prostate cancer risk associated with TRT.

This population based case-control study explores this question. The authors performed multivariate analysis in 38,570 men diagnosed with prostate cancer in Sweden from 2009 to 2014 and 192,838 controls. TRT was not independently associated with increased risk of prostate cancer.

In the case-control component of the analysis the authors found that TRT was associated with a higher incidence of favorable risk cancer. They suggest that this finding is due to detection bias as cases managed by TRT may have been more likely to be screened and/or detected. I believe that this assumption is correct, although one could imagine that lack of androgen sensitivity in poorly differentiated cancers might also have a role.

Regardless of the mechanism, this series clearly shows that TRT does not increase the overall risk of prostate cancer in presumably hypogonadal men, which should give those of us who routinely prescribe this drug some relief. Unfortunately the study does not address whether it is safe to prescribe TRT in men with known prostate cancer, which may be the more important question. It is certainly a question asked by many of my patients who are prostate cancer survivors.

Penson DF. Re: Testosterone Replacement Therapy and Risk of Favorable and Aggressive Prostate Cancer. The Journal of urology 2018;199:19-20. http://www.jurology.com/article/S0022-5347(17)77653-7/fulltext