Testosterone and Prostate Cancer—Recent Research Contradicts Prevailing Medical Thought
“Although the number of men studied here is relatively small, it is clear that the conventional wisdom is wrong that raising testosterone in men with prostate cancer will necessarily precipitate rapid progression and/or death.”
This controversial statement was made by Dr. Abraham Morgentaler, an associate professor of surgery in the department of urology at Beth Israel Deaconess Medical Center, Harvard Medical School, and author of more than 170 scientific articles on testosterone, prostate cancer, male sexual dysfunction, and male infertility.
His research indicates that TRT (Testosterone Replacement Therapy) may not cause unexpected or rapid disease progression in men with prostate cancer (PCa), which contradicts what the medical community has said for decades.
Testosterone and Prostate Cancer: The Historical Perspective
Historically, the medical community has recommended Androgen Deprivation Therapy (ADT), the intentional lowering of testosterone levels, for men with biochemical recurrence or metastatic forms of prostate cancer.
It was thought that testosterone fed prostate tumors, and this practice would therefore slow their growth and delay the overall disease progression. Therefore, maintaining healthy testosterone levels or restoring levels to a healthy range seemed a risky proposition at best.
The Research Methods
Researchers analyzed data from 22 men receiving TRT from 2005 to June 2020—7 subjects suffered from biochemical recurrence of PCa, 13 from metastatic PCa, and 2 were treated with androgen deprivation therapy for high risk of recurrence after their cancer had been successfully treated at other medical facilities.
Throughout the observation period, TRT increased median PSA (Prostate Specific Antigen) from 3.1 ng/mL to 13.3 ng/mL in subjects with biochemical recurrence, from 6.3 ng/mL to 17.8 ng/mL in those suffering from metastatic prostate cancer, and from less than 0.1 ng/mL to 0.3 ng/mL in those treated with androgen deprivation therapy.
The overall mortality rate was 13.6% and the PCa-specific mortality rate was 4.5%.
Notably, the biochemical recurrence group had no fatalities. Only one participant developed metastases after 16 months of testosterone therapy. There were no other complications observed, with four men continuing testosterone therapy for as long as 5 years.
The metastatic prostate cancer group had a 21.4% overall mortality rate and a prostate cancer-specific mortality rate of 7.1%. Among the 10 subjects that had follow-up imaging within a year of initiating TRT, 7 showed no sign of disease progression, while three had some new bone metastases.
Potential Benefits of TRT for Men With Prostate Cancer
Men suffering with both low testosterone and prostate cancer were previously thought to have no real treatment option to improve their quality of life that wouldn’t also significantly increase the severity of their cancer and hasten the end of their lives. However, this study found that:
- Nearly all men experienced increased vigor and improved sexual desire and ability
- Several men were able to resume sexual activity after years without it, particularly those who had induced low testosterone through ADT
- One man was reported to have gained enough strength to no longer need a walker
- Several men and their partners reported they seemed much more like themselves, that their personality had returned
- One regained fluency of speech and brain processing that had been severely depleted while on ADT
Of course, the most important observation made by this study is that TRT was not associated with rapid disease progression.
“Bit by bit over the last 20 years, the urological community has recognized that testosterone therapy can provide important benefits to men and does not appear to worsen outcomes in men with localized prostate cancer or those men being carefully observed with active surveillance for low-risk prostate cancer,” said Dr. Morgentaler.
TRT and Prostate Cancer: More Research Needed
All that said, there are also medical experts who are still skeptical. Jesse Ory, MD, a urologist, and Ranjith Ramasamy, MD, had the following comments in their editorial review of the research results:
“Although there is no doubt that these men likely had symptoms severely impacting their quality of life, these data stress the importance of involving the patient’s oncologist and thoroughly counseling them as to the risks of pursuing testosterone in this disease state.”
They had some suggestions for alternate treatment options that also needed further study. They also called for additional research on the subject overall to be conducted before the common practices are thrown out or significantly altered.
TRT and Prostate Cancer: What This All Means
In summary, these findings are a positive step. The authors of the study provide hope that TRT will soon be made available to men with prostate cancer or prostate cancer histories who are simultaneously suffering the symptoms of Low T.
However, more research is certainly needed to eliminate the potential negative outcomes—cancer is a serious disease with serious consequences. Patient safety and the prevention of cancer recurrence must be the medical community’s highest priority.