Does Testosterone Treatment cause Prostate Cancer

Does Testosterone Treatment cause Prostate Cancer?

Takeaway First

Short-term testosterone treatment (TT) is a safe “Band-Aid” for men with low testosterone (T).  According to this review of studies, TT does not promote prostate cancer development in men when followed for short period of time.

Here are the details:

•    A total of over 2,300 men were studied.
•    These 22 studies were placebo-controlled, randomized, and double-blind
•    Short-term TT delivered by transdermal application (through a patch) was more likely to increase the levels of prostate-specific antigens (PSA) than treatment with a placebo.
•    TT is known to be safe in the short term as it does not promote prostate cancer development or progression.  More research is needed about the long-term effects.

The universal belief that TT leads to prostate cancer development is more than 60 years old.  When older guys lost their vim back in the day, going in for TT was assumed to be a trade-off: feel better, but promote prostate cancer development.

Historical Perspective of the Testosterone / Prostate Cancer confusion

It all started with the work of Dr. Charles B. Huggins, an urologist at the University of Chicago, circa 1940.

Dr. Huggins began experimenting on the effects of castration on dogs with enlarged prostates (BPH).  (After all, dogs are the only non-human animals we know of that naturally develop prostate problems. Huggins observed that the dogs’ prostates shrunk after castration. But that was not all he observed. Dr. Huggins also noticed that dogs with cancerous-appearing areas also demonstrated prostate shrinkage. When their prostates were removed, the cancerous areas cleared up.
As an experiment, Huggins and his research team then removed the testicles or applied estrogen to a group of men who had metastatic prostate cancer to their bones.  At the time the PSA test did not exist, and a blood test called acid phosphatase, typically high in men with prostate cancer that had spread to their bones, was used to determine the progression of the disease. Indeed, Huggins and his team showed that acid phosphatase dropped substantially within days of lowering testosterone – and injecting testosterone to men with prostate cancer caused acid phosphatase to rise. They concluded that reducing testosterone levels caused prostate cancer to shrink, and that raising testosterone levels caused it to grow.
Where are we now with Testosterone and Prostate Cancer?
There is no evidence that TT promotes the development of new cancer of the prostate.
Some evidence even suggests that normal testosterone levels can protect a person from prostate cancer. Many studies have demonstrated that a low testosterone level prior to prostate cancer treatment is an independent predictor of more aggressive, high-grade cancer (Massengill et al., 2003).
Testosterone depletion, also known as androgen deprivation therapy (ADT) is a common treatment for prostate cancer.
ADT does not extend the lives of men with low-risk prostate cancer, reports a recent article from the New York Times.

What should you do?
1.    Ask your doctor to check your total testosterone and free testosterone level, especially if you are over 50 and have low energy, low sexual desire, and memory problems. These symptoms suggest but do not guarantee that you have low testosterone.
2.    If your doctor finds you have low testosterone, then TT may be appropriate under medical supervision, but not by the muscle-headed trainer at your local gym!
3.    Let me emphasize that TT by itself is a “Band-Aid” to the problem.  It’s a good temporary solution, but it is not a cure.  The long-lasting cure usually lies in a long-lasting change of lifestyle.
4.    Cause of low testosterone include chronic high stress, poor sleep habits, lack of physical activity, being overweight…you know, the typical culprits to most health problems.
5.    If you have had prostate cancer and have been successfully treated with an undetectable PSA for two years or more, you may be a candidate for TT but only under medical superviosn.

References:
Massengill JC, Sun L, Moul JW, Wu H, McLeod DG, Amling C et al.  (2003). Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy.  J Urol  169: 1670-1675.
Cui Y, Zong H, Yan H, Zhang Y. (2014). The effect of testosterone replacement therapy on prostate cancer: a systematic review and meta-analysis.  Prostate Cancer Prostatic Dis. 17(2):132-43.  doi: 10.1038/pcan.2013.60