Testosterone has important benefits for men. When it’s at a normal level, it helps develop muscle mass, decrease fat, avoid depression, keep bones strong, maintain libido, improve erections, and may help reduce risks of cardiovascular and cognitive disease. However, about 40% of men over the age of 45 have symptoms of reduced blood levels of testosterone. “Low T” results in less energy, low libido, ED and depression. If properly diagnosed, there is a solution: testosterone replacement therapy (TRT).
However, for many decades it was believed that prostate cancer (PCa) patients with low T could not take advantage of TRT because it would fuel the growth and increased aggressiveness of the tumor. During the last five years, the debate on this matter became more energetic. A growing body of research now shows that TRT is safe for PCa patients on Active Surveillance (AS). For example, in my blog post at https://sperlingprostatecenter.com/active-surveillance-testosterone-replacement-therapy/ I cite a 2015 study out of Men’s Health Boston showing that men on AS who used TRT had no greater PCa growth or progression risk than those who did not.[i] This year, a presentation at the 2016 annual meeting of the Canadian Urological Association likewise found that TRT was safe for low T prostate cancer patients.[ii] The study cohort included 8 PCa patients on AS as well as 50 who had radiation therapy, 22 who had prostatectomy, 1 cryo case and 1 HIFU case. Median follow up was 41 months. The results showed an increase in testosterone and PSA (which normally occurs with TRT) but no progression of PCa on biopsy. This research group also concluded that TRT is safe for PCa patients regardless of treatment.
A newly published multiparametric MRI imaging study from Memorial Sloane Kettering Cancer Center backs these studies up.[iii] The authors tracked 12 AS patients whose cancer was monitored by mpMRI before and during TRT use. Though the number of patients is small, the results are equally consistent with the other two papers. More importantly, the MSK team not only confirmed that TRT effectively boosts testosterone without aggravating prostate cancer, it also demonstrated that mpMRI is a “useful option” for monitoring cancer status while using TRT during Active Surveillance. In fact, mpMRI detected disease progression in 2 men (attributed to the natural history of prostate cancer but not TRT). One of them chose to have prostatectomy while the other remained on AS. Dr. Herbert Vargas, a study author, stated that “validated mpMRI may help the clinician to monitor patients treated with TRT even if PSA elevation is observed while on AS.”[iv]
The Sperling Prostate Center offers 3T mpMRI for the detection, diagnosis and treatment of prostate cancer. Prostate cancer patients on Active Surveillance who are concerned about low T should be tested by a doctor to determine if testosterone blood levels are causing symptoms. If TRT is prescribed, our expert services can monitor for disease progression. For more information, call (561) 948-3461.
[i] Kacker R, Mariam H, San Francisco IF, Conners WP et al. Can testosterone therapy be offered to men on active surveillance for prostate cancer? Preliminary results. Asian J Androl. 2015 Aug 21. doi: 10.4103/1008-682X.160270.
[ii] Charnow, Jody. “Testosterone Replacement Safe for Men with Prostate Cancer.” Renal and Urology News, June 27, 2016. http://www.renalandurologynews.com/canadian-urological-association/testosterone-replacement-safe-for-men-with-prostate-cancer/article/505807/
[iii] Hashimoto T, Rahul K, Takeda T, Benfante N et al. Prostate magnetic resonance imaging findings in patients treated for testosterone deficiency while on active surveillance for low-risk prostate cancer. Urol Oncol. 2016 Sep 21. pii: S1078-1439(16)30167-3. doi: 10.1016/j.urolonc.2016.07.004. [Epub ahead of print]
[iv] Persaud, Natasha. “Study: mpMRI Findings in Prostate Cancer Patients Unaffected by TRT.” Renal and Urology News, Sep. 30, 2016. http://www.renalandurologynews.com/prostate-cancer/study-mpmri-findings-in-prostate-cancer-patients-unaffected-by-trt/article/525999/