Testosterone therapy and prostate cancer

Abstract

While the benefits of testosterone (T) therapy are well documented with regard to the clinical signs and symptoms of T deficiency, there is still a fear among the medical community that T therapy could be a stimulus for the emergence of prostate cancer (PCa) or promote its progression. However, the evidence shows that T appears to have limited stimulatory effects on the prostate. Several studies suggest that T stimulates the growth of prostatic neoplasia only at very low concentrations, and variations in the endogenous T levels within the physiological range or above do not appear to influence prostate growth or function, as measured by markers such as prostate-specific antigen. The recognition of the finite ability of androgens to stimulate prostate growth, called the saturation model, has led to important changes in medical practice, especially with regard to consideration of T therapy for men with a history of PCa. Recent clinical experiences with men with PCa have suggested that T therapy is not as risky as once believed. Studies regarding T administration in hypogonadal men after PCa treatment have shown no evidence of worse oncologic prognosis. Even in patients in active surveillance protocols, T has been administrated with no modification of oncologic outcomes, suggesting that T therapy is safe when correctly indicated and strictly monitored.