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.
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.
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.