Testosterone Treatment
Linked With Prostate Cancer
Prostate
cancer developed in 20 men within months to a few years after
they began testosterone supplementation to correct a deficiency
of the hormone, investigators report.
"There are several anecdotal case reports, small studies, and
observational studies like ours which raise concern but do not
provide conclusive evidence yet," Dr. Franklin D. Gaylis stated.
The issue is a concern because prostate cancer is usually driven
by testosterone.
Gaylis, from the University of California at San Diego Medical
Center, and colleagues report this series of patients "in whom
clinically significant prostate cancer developed and was presumed
to be related to exogenous testosterone use," in the Journal of
Urology.
The men were identified in six different urology practices. Prostate
cancer was detected within 2 years of the start of testosterone
replacement in 11 of these men, seven of them within the first
year, the authors report. The others were diagnosed after 28 months
to 8 years.
Eleven men had normal prostate exams before testosterone supplementation
was begun, the report indicates, and the average PSA level of
the 17 men tested before treatment was 3, although the range was
0.9 to 15. The threshold for further evaluation is usually 4.
"It is our belief that men, especially those with a family history
of prostate cancer, should not receive a prescription for testosterone
supplementation without careful, informed consultation regarding
the risks and benefits of such treatment," the investigators conclude.
"I would hope that guidelines would be developed by experts in
the field to help us appropriately and carefully prescribe testosterone
replacement to men who clearly need it and who would benefit from
it, and then monitor them for potential adverse outcomes, e.g.,
the development of prostate cancer," Gaylis said.
While the study has flaws, writes Dr. E. Darracott Vaughan, Jr.
from Weill Medical College of Cornell University, New York, in
a related editorial, it "can be taken as a 'shot across the bow'
for urologists and other physicians. We need to be extremely careful
before beginning testosterone therapy."
SOURCE: Journal of Urology, August 2005.
Reference
Source 89
August
15, 2005
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