Skip to main content
Top
Published in: Current Urology Reports 6/2010

01-11-2010

Androgen Replacement Therapy After Prostate Cancer Treatment

Author: Mohit Khera

Published in: Current Urology Reports | Issue 6/2010

Login to get access

Abstract

Historically, testosterone supplementation has been avoided in men with a history of prostate cancer because of concern about prostate cancer progression or recurrence. However, recently published data suggest that this concern may not be well founded. The recurring presence of prostate-specific antigen in men with hypogonadism being treated with testosterone after prostatectomy is far less than the expected natural recurrence rate of the disease. There are many theories (including the prostate saturation theory) that may help us understand why testosterone may be safely administered in men with hypogonadism after surgical treatment of prostate cancer. Finally, because patients with hypogonadism already may be at a significant disadvantage in recovering their erectile function after prostatectomy, they perhaps should receive special consideration as candidates for androgen replacement therapy.
Literature
1.
go back to reference • Morgentaler A: Testosterone therapy in men with prostate cancer: scientific and ethical considerations. J Urol 2009, 181:972–979. This is an excellent review on the ethical considerations of testosterone replacement therapy after prostate cancer treatment. CrossRefPubMed • Morgentaler A: Testosterone therapy in men with prostate cancer: scientific and ethical considerations. J Urol 2009, 181:972–979. This is an excellent review on the ethical considerations of testosterone replacement therapy after prostate cancer treatment. CrossRefPubMed
2.
go back to reference Morales A, Black AM, Emerson LE: Testosterone administration to men with testosterone deficiency syndrome after external beam radiotherapy for localized prostate cancer: preliminary observations. BJU Int 2009, 103:62–64.CrossRefPubMed Morales A, Black AM, Emerson LE: Testosterone administration to men with testosterone deficiency syndrome after external beam radiotherapy for localized prostate cancer: preliminary observations. BJU Int 2009, 103:62–64.CrossRefPubMed
3.
go back to reference Morgentaler A: Guilt by association: a historical perspective on Huggins, testosterone therapy, and prostate cancer. J Sex Med 2008, 5:1834–1840.CrossRefPubMed Morgentaler A: Guilt by association: a historical perspective on Huggins, testosterone therapy, and prostate cancer. J Sex Med 2008, 5:1834–1840.CrossRefPubMed
5.
go back to reference Mulligan T, Frick MF, Zuraw QC, et al.: Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract 2006, 60:762–769.CrossRefPubMed Mulligan T, Frick MF, Zuraw QC, et al.: Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract 2006, 60:762–769.CrossRefPubMed
6.
go back to reference Steidle C, Schwartz S, Jacoby K, et al.: AA2500 testosterone gel normalizes androgen levels in aging males with improvements in body composition and sexual function. J Clin Endocrinol Metab 2003, 88:2673–2681.CrossRefPubMed Steidle C, Schwartz S, Jacoby K, et al.: AA2500 testosterone gel normalizes androgen levels in aging males with improvements in body composition and sexual function. J Clin Endocrinol Metab 2003, 88:2673–2681.CrossRefPubMed
7.
go back to reference Dean JD, Carnegie C, Rodzvilla J, Smith T: Long-term effects of testim(r) 1% testosterone gel in hypogonadal men. Rev Urol 2004, 6(Suppl 6):S22–S29.PubMed Dean JD, Carnegie C, Rodzvilla J, Smith T: Long-term effects of testim(r) 1% testosterone gel in hypogonadal men. Rev Urol 2004, 6(Suppl 6):S22–S29.PubMed
8.
go back to reference Bolla M, Collette L, Blank L, et al.: Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet 2002, 360:103–106.CrossRefPubMed Bolla M, Collette L, Blank L, et al.: Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet 2002, 360:103–106.CrossRefPubMed
9.
go back to reference Messing EM, Manola J, Sarosdy M, et al.: Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med 1999, 341:1781–1788.CrossRefPubMed Messing EM, Manola J, Sarosdy M, et al.: Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med 1999, 341:1781–1788.CrossRefPubMed
10.
go back to reference Thompson IM, Goodman PJ, Tangen CM, et al.: The influence of finasteride on the development of prostate cancer. N Engl J Med 2003, 349:215–224.CrossRefPubMed Thompson IM, Goodman PJ, Tangen CM, et al.: The influence of finasteride on the development of prostate cancer. N Engl J Med 2003, 349:215–224.CrossRefPubMed
11.
go back to reference Huggins C, Hodges CV: The effect of castration, of estrogen and androgen injection on serum phosphatase in metastatic carcinoma of the prostate. Cancer Res 1941, 1:293–297. Huggins C, Hodges CV: The effect of castration, of estrogen and androgen injection on serum phosphatase in metastatic carcinoma of the prostate. Cancer Res 1941, 1:293–297.
12.
go back to reference Morgentaler A: Testosterone and prostate cancer: an historical perspective on a modern myth. Eur Urol 2006, 50:935–939.CrossRefPubMed Morgentaler A: Testosterone and prostate cancer: an historical perspective on a modern myth. Eur Urol 2006, 50:935–939.CrossRefPubMed
13.
go back to reference • Shabsigh R, Crawford ED, Nehra A, Slawin KM: Testosterone therapy in hypogonadal men and potential prostate cancer risk: a systematic review. Int J Impot Res 2009, 21:9–23. This article is one of the largest meta-analyses assessing the incidence of prostate cancer in men treated with testosterone. They found no increased incidence of prostate cancer in men treated with testosterone. CrossRefPubMed • Shabsigh R, Crawford ED, Nehra A, Slawin KM: Testosterone therapy in hypogonadal men and potential prostate cancer risk: a systematic review. Int J Impot Res 2009, 21:9–23. This article is one of the largest meta-analyses assessing the incidence of prostate cancer in men treated with testosterone. They found no increased incidence of prostate cancer in men treated with testosterone. CrossRefPubMed
14.
go back to reference Calof OM, Singh AB, Lee ML, et al.: Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci 2005, 60:1451–1457.PubMed Calof OM, Singh AB, Lee ML, et al.: Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci 2005, 60:1451–1457.PubMed
15.
go back to reference Endogenous Hormones and Prostate Cancer Collaborative Group; Roddam AW, Allen NE, Appleby P, Key TJ: Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst 2008, 100:170–183.CrossRefPubMed Endogenous Hormones and Prostate Cancer Collaborative Group; Roddam AW, Allen NE, Appleby P, Key TJ: Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst 2008, 100:170–183.CrossRefPubMed
16.
go back to reference Monath JR, McCullough DL, Hart LJ, Jarow JP: Physiologic variations of serum testosterone within the normal range do not affect serum prostate-specific antigen. Urology 1995, 46:58–61.CrossRefPubMed Monath JR, McCullough DL, Hart LJ, Jarow JP: Physiologic variations of serum testosterone within the normal range do not affect serum prostate-specific antigen. Urology 1995, 46:58–61.CrossRefPubMed
17.
go back to reference Bhasin S, Storer TW, Berman N, et al.: The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Engl J Med 1996, 335:1–7.CrossRefPubMed Bhasin S, Storer TW, Berman N, et al.: The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Engl J Med 1996, 335:1–7.CrossRefPubMed
18.
go back to reference Cooper CS, Perry PJ, Sparks AE, et al.: Effect of exogenous testosterone on prostate volume, serum and semen prostate specific antigen levels in healthy young men. J Urol 1998, 159:441–443.CrossRefPubMed Cooper CS, Perry PJ, Sparks AE, et al.: Effect of exogenous testosterone on prostate volume, serum and semen prostate specific antigen levels in healthy young men. J Urol 1998, 159:441–443.CrossRefPubMed
19.
go back to reference Hoffman MA, DeWolf WC, Morgentaler A: Is low serum free testosterone a marker for high grade prostate cancer? J Urol 2000, 163:824–827.CrossRefPubMed Hoffman MA, DeWolf WC, Morgentaler A: Is low serum free testosterone a marker for high grade prostate cancer? J Urol 2000, 163:824–827.CrossRefPubMed
20.
go back to reference Grober ED, Lamb DJ, Khera M, et al.: Correlation between simultaneous PSA and serum testosterone concentrations among eugonadal, untreated hypogonadal and hypogonadal men receiving testosterone replacement therapy. Int J Impot Res 2008, 20:561–565.CrossRefPubMed Grober ED, Lamb DJ, Khera M, et al.: Correlation between simultaneous PSA and serum testosterone concentrations among eugonadal, untreated hypogonadal and hypogonadal men receiving testosterone replacement therapy. Int J Impot Res 2008, 20:561–565.CrossRefPubMed
21.
go back to reference Marks LS, Mazer NA, Mostaghel E, et al.: Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA 2006, 296:2351–2361.CrossRefPubMed Marks LS, Mazer NA, Mostaghel E, et al.: Effect of testosterone replacement therapy on prostate tissue in men with late-onset hypogonadism: a randomized controlled trial. JAMA 2006, 296:2351–2361.CrossRefPubMed
22.
go back to reference Khera M, Miner M, Bhattacharya R, et al.: PSA levels significantly rise after 3 months of testosterone replacement therapy in severely hypogonadal men in the Testim registry in the US (TRIUS) cohort [abstract 1379]. J Urol 2010, 183(Suppl):e533.CrossRef Khera M, Miner M, Bhattacharya R, et al.: PSA levels significantly rise after 3 months of testosterone replacement therapy in severely hypogonadal men in the Testim registry in the US (TRIUS) cohort [abstract 1379]. J Urol 2010, 183(Suppl):e533.CrossRef
23.
go back to reference Behre HM, Bohmeyer J, Nieschlag E: Prostate volume in testosterone-treated and untreated hypogonadal men in comparison to age-matched normal controls. Clin Endocrinol (Oxf) 1994, 40:341–349.CrossRef Behre HM, Bohmeyer J, Nieschlag E: Prostate volume in testosterone-treated and untreated hypogonadal men in comparison to age-matched normal controls. Clin Endocrinol (Oxf) 1994, 40:341–349.CrossRef
24.
go back to reference Ho SM, Damassa D, Kwan PW, et al.: Androgen receptor levels and androgen contents in the prostate lobes of intact and testosterone-treated Noble rats. J Androl 1985, 6:279–290.PubMed Ho SM, Damassa D, Kwan PW, et al.: Androgen receptor levels and androgen contents in the prostate lobes of intact and testosterone-treated Noble rats. J Androl 1985, 6:279–290.PubMed
25.
go back to reference Traish AM, Williams DF, Hoffman ND, Wotiz HH: Validation of the exchange assay for the measurement of androgen receptors in human and dog prostates. Prog Clin Biol Res 1988, 262:145–160.PubMed Traish AM, Williams DF, Hoffman ND, Wotiz HH: Validation of the exchange assay for the measurement of androgen receptors in human and dog prostates. Prog Clin Biol Res 1988, 262:145–160.PubMed
26.
go back to reference •• Morgentaler A, Traish AM: Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol 2009, 55:310–321. This manuscript describes the prostate saturation model and is the basis for our understanding of how testosterone may affect PSA and prostate cancer. CrossRefPubMed •• Morgentaler A, Traish AM: Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol 2009, 55:310–321. This manuscript describes the prostate saturation model and is the basis for our understanding of how testosterone may affect PSA and prostate cancer. CrossRefPubMed
27.
go back to reference Heracek J, Hampl R, Hill M, et al.: Tissue and serum levels of principal androgen in benign prostatic hyperplasia and prostate cancer. Steroids 2007, 72:375–380. (Published erratum appears in Steroids 2008, 73:148.)CrossRefPubMed Heracek J, Hampl R, Hill M, et al.: Tissue and serum levels of principal androgen in benign prostatic hyperplasia and prostate cancer. Steroids 2007, 72:375–380. (Published erratum appears in Steroids 2008, 73:148.)CrossRefPubMed
28.
go back to reference Tomera K, Gleason D, Gittelman M, et al.: The gonadotropin-releasing hormone antagonist abarelix depot versus luteinizing hormone releasing hormone agonists leuprolide or goserelin: initial results of endocrinological and biochemical efficacies in patients with prostate cancer. J Urol 2001, 165:1585–1589.CrossRefPubMed Tomera K, Gleason D, Gittelman M, et al.: The gonadotropin-releasing hormone antagonist abarelix depot versus luteinizing hormone releasing hormone agonists leuprolide or goserelin: initial results of endocrinological and biochemical efficacies in patients with prostate cancer. J Urol 2001, 165:1585–1589.CrossRefPubMed
29.
go back to reference Agarwal PK, Oefelein MG: Testosterone replacement therapy after primary treatment for prostate cancer. J Urol 2005, 173:533–536.CrossRefPubMed Agarwal PK, Oefelein MG: Testosterone replacement therapy after primary treatment for prostate cancer. J Urol 2005, 173:533–536.CrossRefPubMed
30.
go back to reference Kaufman JM, Graydon RJ: Androgen replacement after curative radical prostatectomy for prostate cancer in hypogonadal men. J Urol 2004, 172:920–922.CrossRefPubMed Kaufman JM, Graydon RJ: Androgen replacement after curative radical prostatectomy for prostate cancer in hypogonadal men. J Urol 2004, 172:920–922.CrossRefPubMed
31.
go back to reference Khera M, Grober ED, Najari B, et al.: Testosterone replacement therapy following radical prostatectomy. J Sex Med 2009, 6:1165–1170.CrossRefPubMed Khera M, Grober ED, Najari B, et al.: Testosterone replacement therapy following radical prostatectomy. J Sex Med 2009, 6:1165–1170.CrossRefPubMed
32.
go back to reference Sathyamoorthy K, Stein M, Mohammed O, et al.: Testosterone replacement therapy in high risk patients following radical prostatectomy [abstract 1498]. J Urol 2010, 183(Suppl):e577.CrossRef Sathyamoorthy K, Stein M, Mohammed O, et al.: Testosterone replacement therapy in high risk patients following radical prostatectomy [abstract 1498]. J Urol 2010, 183(Suppl):e577.CrossRef
33.
go back to reference Sarosdy MF: Testosterone replacement for hypogonadism after treatment of early prostate cancer with brachytherapy. Cancer 2007, 109:536–541.CrossRefPubMed Sarosdy MF: Testosterone replacement for hypogonadism after treatment of early prostate cancer with brachytherapy. Cancer 2007, 109:536–541.CrossRefPubMed
34.
go back to reference Davila HH, Arison CN, Hall MK, et al.: Analysis of the PSA response after testosterone supplementation in patients who previously received management for their localized prostate cancer [abstract]. J Urol 2008, 179(Suppl):428.CrossRef Davila HH, Arison CN, Hall MK, et al.: Analysis of the PSA response after testosterone supplementation in patients who previously received management for their localized prostate cancer [abstract]. J Urol 2008, 179(Suppl):428.CrossRef
35.
go back to reference Nabulsi O, Tal R, Gotto G, et al.: Outcomes analysis of testosterone supplementation in hypogonadal men following radical prostatectomy. J Urol 2008, 179(Suppl):426–427.CrossRef Nabulsi O, Tal R, Gotto G, et al.: Outcomes analysis of testosterone supplementation in hypogonadal men following radical prostatectomy. J Urol 2008, 179(Suppl):426–427.CrossRef
36.
go back to reference Isbam H, Fisch M, Huland H, et al.: Testosterone treatment after radical prostatectomy for pathologically organ-confined prostate cancer: results from a multi-institutional study [abstract 1496]. J Urol 2010, 183(Suppl):e576–e577. Isbam H, Fisch M, Huland H, et al.: Testosterone treatment after radical prostatectomy for pathologically organ-confined prostate cancer: results from a multi-institutional study [abstract 1496]. J Urol 2010, 183(Suppl):e576–e577.
37.
go back to reference Kattan MW, Eastham JA, Stapleton AM, et al.: A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst 1998, 90:766–771.CrossRefPubMed Kattan MW, Eastham JA, Stapleton AM, et al.: A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J Natl Cancer Inst 1998, 90:766–771.CrossRefPubMed
38.
go back to reference Ward JF, Blute ML, Slezak J, et al.: The long-term clinical impact of biochemical recurrence of prostate cancer 5 or more years after radical prostatectomy. J Urol 2003, 170:1872–1876CrossRefPubMed Ward JF, Blute ML, Slezak J, et al.: The long-term clinical impact of biochemical recurrence of prostate cancer 5 or more years after radical prostatectomy. J Urol 2003, 170:1872–1876CrossRefPubMed
39.
go back to reference van Oort IM, Kok DE, Kiemeney LA, et al.: A single institution experience with biochemical recurrence after radical prostatectomy for tumors that on pathology are of small volume or “insignificant.” Urol Oncol 2009, 27:509–513.PubMed van Oort IM, Kok DE, Kiemeney LA, et al.: A single institution experience with biochemical recurrence after radical prostatectomy for tumors that on pathology are of small volume or “insignificant.” Urol Oncol 2009, 27:509–513.PubMed
40.
go back to reference Berger R, Febbo PG, Majumder PK, et al.: Androgen-induced differentiation and tumorigenicity of human prostate epithelial cells. Cancer Res 2004, 64:8867–8875.CrossRefPubMed Berger R, Febbo PG, Majumder PK, et al.: Androgen-induced differentiation and tumorigenicity of human prostate epithelial cells. Cancer Res 2004, 64:8867–8875.CrossRefPubMed
41.
go back to reference Bonaccorsi L, Muratori M, Marchiani S, et al.: The androgen receptor and prostate cancer invasion. Mol Cell Endocrinol 2006, 246:157–162.CrossRefPubMed Bonaccorsi L, Muratori M, Marchiani S, et al.: The androgen receptor and prostate cancer invasion. Mol Cell Endocrinol 2006, 246:157–162.CrossRefPubMed
42.
go back to reference Morgentaler A, Rhoden EL: Prevalence of prostate cancer among hypogonadal men with prostate-specific antigen levels of 4.0 ng/mL or less. Urology 2006, 68:1263–1267.CrossRefPubMed Morgentaler A, Rhoden EL: Prevalence of prostate cancer among hypogonadal men with prostate-specific antigen levels of 4.0 ng/mL or less. Urology 2006, 68:1263–1267.CrossRefPubMed
43.
go back to reference Yamamoto S, Yonese J, Kawakami S, et al.: Preoperative serum testosterone level as an independent predictor of treatment failure following radical prostatectomy. Eur Urol 2007, 52:696–701.CrossRefPubMed Yamamoto S, Yonese J, Kawakami S, et al.: Preoperative serum testosterone level as an independent predictor of treatment failure following radical prostatectomy. Eur Urol 2007, 52:696–701.CrossRefPubMed
44.
go back to reference Miller LR, Partin AW, Chan DW, et al.: Influence of radical prostatectomy on serum hormone levels. J Urol 1998, 160:449–453.CrossRefPubMed Miller LR, Partin AW, Chan DW, et al.: Influence of radical prostatectomy on serum hormone levels. J Urol 1998, 160:449–453.CrossRefPubMed
45.
go back to reference Madersbacher S, Schatzl G, Bieglmayer C, et al.: Impact of radical prostatectomy and TURP on the hypothalamic-pituitary-gonadal hormone axis. Urology 2002, 60:869–874.CrossRefPubMed Madersbacher S, Schatzl G, Bieglmayer C, et al.: Impact of radical prostatectomy and TURP on the hypothalamic-pituitary-gonadal hormone axis. Urology 2002, 60:869–874.CrossRefPubMed
46.
go back to reference Türkölmez K, Bozlu M, Sarica K, et al.: Effects of transurethral prostate resection and transurethral laser prostatectomy on plasma hormone levels. Urol Int 1998, 61:162–167.CrossRefPubMed Türkölmez K, Bozlu M, Sarica K, et al.: Effects of transurethral prostate resection and transurethral laser prostatectomy on plasma hormone levels. Urol Int 1998, 61:162–167.CrossRefPubMed
47.
go back to reference Thompson IM, Ankerst DP, Chi C, et al.: Operating characteristics of prostate-specific antigen in men with an initial PSA level of 3.0 ng/ml or lower. JAMA 2005, 294:66–70.CrossRefPubMed Thompson IM, Ankerst DP, Chi C, et al.: Operating characteristics of prostate-specific antigen in men with an initial PSA level of 3.0 ng/ml or lower. JAMA 2005, 294:66–70.CrossRefPubMed
48.
go back to reference Morgentaler A, Sweeney M, Bennett R, et al.: PSA and follow-up biopsy results in men who received testosterone therapy while on active surveillance for prostate cancer [abstract 1376]. J Urol 2010, 183(Suppl):e531–e532.CrossRef Morgentaler A, Sweeney M, Bennett R, et al.: PSA and follow-up biopsy results in men who received testosterone therapy while on active surveillance for prostate cancer [abstract 1376]. J Urol 2010, 183(Suppl):e531–e532.CrossRef
49.
go back to reference •• Khera M: Androgens and erectile function: a case for early androgen use in postprostatectomy hypogonadal men. J Sex Med 2009, 6(Suppl 3):234–238. This manuscript is the first to support the use of testosterone supplementation in penile rehabilitation following radical prostatectomy. CrossRefPubMed •• Khera M: Androgens and erectile function: a case for early androgen use in postprostatectomy hypogonadal men. J Sex Med 2009, 6(Suppl 3):234–238. This manuscript is the first to support the use of testosterone supplementation in penile rehabilitation following radical prostatectomy. CrossRefPubMed
50.
go back to reference Khera M, Miner M, Bhattacharya R, et al.: Testosterone supplementation significantly improves depression symptoms in hypogonadal men enrolled in the Testim registry in the US (TRIUS) [abstract 1479]. J Urol 2010, 183(Suppl):e578.CrossRef Khera M, Miner M, Bhattacharya R, et al.: Testosterone supplementation significantly improves depression symptoms in hypogonadal men enrolled in the Testim registry in the US (TRIUS) [abstract 1479]. J Urol 2010, 183(Suppl):e578.CrossRef
51.
go back to reference Traish AM, Guay AT: Are androgens critical for penile erections in humans? Examining the clinical and preclinical evidence. J Sex Med 2006, 3:382–404.CrossRefPubMed Traish AM, Guay AT: Are androgens critical for penile erections in humans? Examining the clinical and preclinical evidence. J Sex Med 2006, 3:382–404.CrossRefPubMed
52.
go back to reference Mulhall JP, Morgentaler A: Penile rehabilitation should become the norm for radical prostatectomy patients. J Sex Med 2007, 4:538–543.CrossRefPubMed Mulhall JP, Morgentaler A: Penile rehabilitation should become the norm for radical prostatectomy patients. J Sex Med 2007, 4:538–543.CrossRefPubMed
Metadata
Title
Androgen Replacement Therapy After Prostate Cancer Treatment
Author
Mohit Khera
Publication date
01-11-2010
Publisher
Current Science Inc.
Published in
Current Urology Reports / Issue 6/2010
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-010-0143-3

Other articles of this Issue 6/2010

Current Urology Reports 6/2010 Go to the issue