MYTHBUSTING: Androgen Risk for Prostate Cancer and AntiAndrogen therapy for Most (ie Older) Men with Prostate Cancer

          ARE  PHYSIOLOGICAL ANDROGEN LEVELS, OR ANDROGEN SUPPRESSION THERAPY ie ESTROGEN DOMINANCE, THE GREATER RISK FOR PROSTATE CANCER, QUALITY OF LIFE AND ALL-CAUSE MORTALITY?

Prostate -in 5% of men – and  breast cancer -in 4% of women-  are rarely  the cause of death or long term disability  in caucasians.  So with longevity a growing issue,  the adverse effect of post-midlife sex hormone depletion on other systems- quality of life, muskuloskeletal, mood, immunity and cardiovascular domains, let alone sexuality, is a growing issue. 

The oncologist, the urologist  or breast surgeon presented with a cancer must naturally focus on the immediate issue- deal with the cancer- which may include antihormone therapy. .

 

 The generalist clinician, the family practitioner and longterm carer eg the internist or geriatrician or psychiatrist, on the other hand looks far ahead to the chances of ensuring healthy multisystem longevity after the cancer- for which longterm goals balanced physiological hormone replacement often has merit. .

 

As regards  the risk factors for prostate cancer, Wikipedia sums it up nicely: “Prostate cancer presents clinically at an average age of 70years,  although  found incidentally in about 30% of men in their fifties and 80% of men in their seventies. Prostate cancer affected 18% of American men and caused death in 3% in 2005.  Pollution (eg environmental estrogenics, diethylstilbestrol exposure in utero,  Agent Orange) and genes play perhaps 20% to 80% role, which can hardly be prevented by the individual already in midlife:  In Japan, death from prostate cancer was one-fifth to one-half the rates in the United States and Europe in the 1990s. In India in the 1990s, half of those with cancer confined to the prostate died within ten years. African-American men have 50–60 times more prostate cancer and prostate cancer deaths than men in Shanghai, China. In Nigeria, 2% of men develop prostate cancer and 64% of them are dead after two years.”  

 Dietary:  blood levels of trans fatty acids, (in particular from hydrogenation of vegetable oils), are associated with an increased prostate cancer risk. Other dietary factors that may increase prostate cancer risk include low intake of vitamin E, vitamin D (incl. sunlight),  fish omega-3 fatty acids , and the mineral selenium.” .  

 

Hypocholesterolemia  – whether spontaneous or drug-induced – is associated with increased prostate cancer .

 

Combined vitamins C plus K (in ratio of 100:1)  (Jamison 2001) has also shown promise against prostate cancer.  

 

Huggins got the Nobel prize in  1966 for showing that androgen blockade extended life with  metastatic prostate cancer.

 

BUT what is the relationship between testosterone level and incidence/ severity of prostate cancer and quality of life thereafter?

 

 Oliver & Slater at London University showed already almost a decade ago that men presenting  with prostate cancer have testosterone levels below the average.

 

Abraham Morgantaler  from Boston Mass  this year reviews the increasing evidence that low testosterone, including testosterone blockade, actually increases  mortality from (highgrade) prostate cancer;   let alone the multisystem effects of avoidable sexhormone deficiency (on mood, mind, muscle, skeleton, cardiovascular and immune) that, as in women, probably lose years of healthspan if not also lifespan.

 

Major clinics following cohorts of men long term for well over  a decade  on appropriate physiological testosterone replacement  (after baseline exclusion of cancer markers) report  no increased prostate risk from such replacement , that if anything the incidence of new prostate cancer is half that of their peers; and no cases of subsequent death from prostate cancer in such supervised men have apparently yet been reported.

 

This year :

Shabsingh from Columbia Univ, Rhoden from Brazil  and Morales from Ontario  can still find no evidence that appropriate testosterone replacement increases risk of prostate cancer,  even when commenced after prostate cancer. 

 

Now:

 Dosoreth from Harvard shows the predictable corollary, that treating elderly prostate cancer with anti-androgens  plus radiotherapy XTR  actually gives  20% higher mortality than if   treated with XRT alone.  

 

Horwitz  from Philadelphia puts it practically – treat the cancer with XRT, but   add antiandrogen only if the PSA prostate specific antigen level  rises rapidly.

 

Lu-Yao 2008 shows from SEER USA data  that primary androgen deprivation for prostate cancer actually gave 20% lower prostate-cancer-specific survival over 10 years without reducing  all-cause mortality.

 

Kapoor 2008 and Traish 2008  motivate  that “ Androgen deficiency as a predictor of metabolic syndrome in aging men is an opportunity for intervention”.

 

So the evidence of the past ~70 years grows – as presented at the congresses of the world leaders, the International Society for  Study of Aging Males    and the  International Menopause Society  –  that  in older people, appropriate sexhormone replacement HRT (parenteral testosterone for men, testosterone plus estrogen plus progesterone for women)  to the physiological levels and balance  found before middle age  can actually reduce the risks of cancer death  as well as the risks of all other common  chronic major degenerative disease  (Morales 2008) .

Obviously this is provided HRT  is combined  both with appropriate other microsupplements (minerals vitamins and biologicals eg fish oil, chondroglucosamine, saw palmetto)  and with appropriate surveillance  for and management of cancer, mood, mind, cardiovascular and musculoskeletal systems – which is simple enough for the patient’s personal clinician to handle:  quality of life, memory, mood and sexuality; bloodpressure, bodymass index and waist girth/body fat; breast/pelvic/rectal examination; and occasional appropriate breast/ pelvic imaging, and blood screening- hemoglobin, lipids and PSA prostate specific antigen.    

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