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Testosterone therapy in men with prostate cancer: Scientific and ethical considerations
The Journal of Urology, 02/18/09

Morgentaler A et al. – Although no controlled studies have been performed to date to document the safety of testosterone therapy in men with prostate cancer, the limited available evidence suggests that such treatment may not pose an undue risk of prostate cancer recurrence or progression.

Methods

Pertinent literature regarding the potential use of testosterone therapy in men with prostate cancer is reviewed and synthesized
English language literature search on testosterone administration in men with known prostate cancer history
Investigation of effects of androgen concentrations on prostate parameters, especially prostate specific antigen

Results

Prohibition against testosterone therapy in pts with history of prostate cancer based on model that assumes androgen sensitivity of cancer extends throughout range of testosterone concentrations
Despite this cancer as exquisitely sensitive to changes in serum testosterone at low concentrations, considerable evidence shows that prostate cancer growth becomes androgen indifferent at higher concentrations
Most likely mechanism for this loss of androgen sensitivity at higher testosterone concentrations is finite capacity of androgen receptor to bind androgen
This saturation model explains why serum testosterone appears unrelated to prostate cancer risk in the general population and why testosterone administration in men with metastatic prostate cancer causes rapid progression in castrated but not hormonally intact men
High Gleason score, extracapsular disease and biochemical recurrence after surgery reported in association with low but not high testosterone

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