Cancer

Does Testosterone Replacement Therapy Cause Prostate Cancer?
Prostate cancer develops primarily in men over 50—and it is the most common type of cancer found among men in the United States. Prostate cancer is also the second leading cause of cancer death in American men after lung cancer.

More than 80% of men will develop prostate cancer by their 80th birthday. However, in the majority of cases, it will be slow-growing and will not require treatment. In such men, prostate cancer is over-diagnosed—the needless identification of a technically aberrant condition that will never harm the patient—and treating these men exposes them to all of the adverse effects, with no possibility of extending their lives.1

Many factors, including genetics and diet, have been implicated in prostate cancer development. But does testosterone replacement therapy cause prostate cancer? Since the prostate-testosterone connection is the issue that most worries men and their physicians, it’s important to understand the research when considering testosterone replacement therapy.

The Prostate-Testosterone Connection
Although some studies show a higher rate of prostate events like cancer and prostate enlargement in connection with testosterone replacement therapy, researchers note the differences are not substantial and may be due, in part, to data collection errors. What’s more, the long-standing prohibition against testosterone therapy in men with untreated or low-risk prostate cancer merits reevaluation, according to a new study published in The Journal of Urology.

This study, which is the first to directly and rigorously assess changes in the prostate among men with prostate cancer who received testosterone therapy, suggests the decades-old view is incorrect, and that testosterone treatment in men does not cause rapid growth of prostate cancer.

"For many decades it had been believed that a history of prostate cancer, even if treated and cured, was an absolute contraindication to testosterone therapy, due to the belief that testosterone activated prostate cancer growth, and could potentially cause dormant cancer cells to grow rapidly," says Abraham Morgentaler, MD of Men's Health Boston. "Generations of medical students and residents were taught that providing testosterone to a man with prostate cancer was like pouring gasoline on a fire."

The bottom line: When we look at the rate of prostate cancer in men treated with testosterone, the percentage is 1% per year. When we look at the rate of prostate cancer in men not treated with testosterone, the percentage is 1% per year.1 What’s more, a 2008 review of 18 prospective studies on prostate cancer and testosterone levels revealed that was serum concentrations of all sex hormones, including testosterone, were not associated with an increased risk of prostate cancer.

The Truth About Prostate Cancer and Testosterone
Here is the overarching truth about prostate cancer: There is virtually no instance of prostate cancer among young men. It is only with age and declining testosterone levels, increasing binding protein (which results in even lower free testosterone levels), and increasing estrogen levels that prostate cancer develops.

The Prostate Cancer Prevention Trial, a landmark study of men, reveals that finasteride, known in pharmacies as Proscar, reduced the risk of developing prostate cancer by 25 percent. Researchers attribute this to the effects of Dihydrotestosterone on the androgen receptors inside the prostate cells. A similar study of Avodart also resulted in a 23% reduction in prostate cancer development. Ageology physicians are trained to implement Proscar and Avodart into treatment programs when necessary.  

So where does all this leave men considering testosterone replacement therapy in the light of cancer concerns? Simply put, if prostate cancer is diagnosed in men receiving testosterone therapy, the patient and physician both need to be comfortable that this occurred as a process of life, genetics and diet, and not due to the treatment with testosterone. The benefits of testosterone replacement therapy are substantial and the risks can be minimized by choosing a trained expert in testosterone therapy.

Contact an Ageology physician to learn to discuss the benefits and risks of testosterone therapy. Our first approach to treatment is always to explore beneficial changes in diet, exercise and stress management. We can also evaluate how current prescription drugs could be causing hormone abnormalities, and prescribe customized bioidentical hormone replacement therapies when needed.

1Bostwick, David G.; Eble, John N. (2007). Urological Surgical Pathology. St. Louis: Mosby. p. 468.
2Rhoden EL, Morgentaler A. 2004 Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med 350:482–492