One of the biggest problems for men who have been treated for prostate cancer in the past is not the cancer itself. It’s the fact that as they get older, they need testosterone hormone replacement.
This causes a problem, as even though their cancers have been treated, their doctors are reluctant to give them testosterone.
And that places them at an increased risk of premature aging, fatigue, weakness, arthritis, muscle loss, decreased sexual function, osteoporosis, and cardiovascular disease. The reluctance stems from the fear that giving them testosterone might cause the cancer to come back.
But is there any real reason to worry?
If you’re a man who has had prostate cancer in the past but had it successfully treated with surgery or radiation, would you really have an increased risk of having the cancer come back if you take testosterone therapy? This has been a big concern for both patients and doctors. And now a new study is showing some surprising and yet reassuring answers to the question.
Researchers looked at several groups of men who had been successfully treated for their prostate cancer with either surgery, external beam radiation, or radioactive seed implants (brachytherapy). Their average age was 75.5 years. All of the men had testosterone levels below the normal range. All of them also had one or more of the following testosterone deficiency symptoms: erectile dysfunction, fatigue, reduced libido, mood changes, and weakness. And all of the men were started on testosterone therapy. They followed these men for an average of four years to see if the testosterone placed them at a greater risk for a recurrence of their cancer. Here’s what they found.
Of these men, 50 had their cancers treated with either external beam radiation therapy or radioactive seed implants. Out of that group, three of them had a return of their PSA levels to what they were before the radiation.
However, when the researchers looked at the overall risks of failure of radiation therapy, they were not convinced that the increased PSA levels had anything to do with the testosterone. Their conclusion was that the three cases were just as likely to have reoccurred because the radiation failed.
Another 22 men had successful radical prostatectomy surgery. None of these patients had a significant increase in their PSA levels.
One of the authors of the study, Dr. Jesse Ory of Dalhousie University in Halifax, Nova Scotia, concluded: “Our study supports the hypothesis that testosterone therapy may be safe in hypogonadal men [men with low testosterone levels] after definitive treatment for prostate cancer.” So, if testosterone is safe to give to men with a previous history of prostate cancer, why are doctors afraid to do it?
Ever since a series of landmark studies conducted in the 1940s, there has been controversy over the safety of testosterone therapy. These studies on men with prostate cancer showed that, on average, the higher a man’s testosterone levels were, the faster his prostate cancer would grow. This relationship is further fueled by the fact that when you take testosterone out of the equation in men with prostate cancer – either by surgically removing their testicles or with drugs – the PSAs go down, and the cancer growth stops.
However, a recent review of the 1940 studies found no scientific evidence to suggest that testosterone therapy leads to prostate cancer. Since the middle of the last decade, multiple studies have examined the relationship between testosterone therapy and prostate cancer and found little or no evidence to support a connection. So, does this study mean that it’s a completely safe thing for men who have been previously treated for prostate cancer to get testosterone therapy?
According to Dr. Alexander Pastuszak, of Baylor College of Medicine in Houston, “The problem we have with all of the studies, including mine, is that the cohorts [numbers of men in the studies], across the board, are small. So, while we can say, ‘yeah, it looks safe,’ we can’t say, ‘yeah, it is safe.’” There are three more points I’d like to make about this controversy.
One, all of the men in the study, even though there was no evidence of a recurrence of their cancers, had a slight but definite increase in their PSA levels. So, if you’re going to get upset when you see your PSA levels increase, testosterone is not for you. Two, none of the men being treated with testosterone had initial testosterone levels that were in the so-called normal range. All of them fell below that range.
This study does not look at the effect of testosterone therapy in men with normal levels. And three, these men had an average age of 75.5 years. These results may not be an indication of how younger men would respond.
So, if you are over 70 and have had prostate cancer successfully treated in the past and your testosterone levels are below the normal range, it looks like you’re safe to take testosterone. Not only may it be a safe thing to do, but it may also, in fact, be a smart thing to do.
Yours for better health,
Frank Shallenberger, MD