BERKELEY, CA (UroToday.com) - From the early days, the use of supplemental testosterone (T) in hypogonadal men has been marred with political, ideological and scientific controversy.
The effect of T on the growth and development of the prostate gland is well known and for years it was feared that endogenous T could be a promoter of the development of prostate cancer (PCa). These concerns have been largely put aside by reports clearly indicating that this is not the case. Similarly, it is now commonly accepted that the appropriate administration of T to men with a T deficiency does not induce PCa. A new wrinkle in the controversy has arisen regarding the use of T supplementation to men with PCa. Although the evidence is limited (<500 cases reported in the literature), it is also reassuring to the fact that hypogonadal men successfully treated for PCa can receive supplemental T with impunity. These are men with a past history of PCa but without clinically demonstrable PCa.
A more recent but no less contentious issue is the use of T in hypogonadal men with untreated PCa. The evidence for and against is miniscule: less than 20 cases in the world literature. There is one study indicating that none of 13 men so treated experienced exacerbation of their malignancy. The other smaller and simultaneous study showed that the responses are variable. While some men indeed suffered no exacerbation, others clearly showed reactivation of their cancer as determined by proxy parameters (PSA). Presently there are no means available to determine a priori the inter-individual biological variability factors that would allow or prevent the use of T in some men with PCa but not in others. The gist of the second study is that clinicians must remain cautious until credible evidence is available on the safety of T in this situation. In addition, because these cases are not everyday occurrences, an international registry should be established to allow a prompter accrual of evidence to clarify the developing controversy.
Alvaro Morales, MD, FRCS(C), FACS as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.