the poster summarised below was presented earlier this month at the German Society of Andrology.
It may be the first published controlled study confirming the apparent prostate benefit of appropriate testosterone replacement TRT for a mean of 30 months in hypogonadal men compared to comparably monitored eugonadal men. The numbers are small, but show perhaps halving of the incidence (to 0.5% new prostate cancers per year) and severity of the cancers.
As previously discussed in this column, this reduction in incidence and grade of malignancy is what we have grown to expect with appropriate parenteral HRT, as also seen in hypogonadal women to produce balanced testosterone:progesterone: estradiol levels and lesser breast cancer and cancer mortality. .
“No Higher Incidence of Prostate Cancer in Hypogonadal Patients being Treated with Exogenous Testosterone 1Aksam A. Yassin, 2 Farid Saad, 3 Ahmad Haider, 4 Osama Assaad. 1 Gulf Medical College UAE & Segeberger Kliniken, Noderstedt-Hamburg, Germany, 2 Gulf Medical College UAE, & Bayer Schering Germany, 3 Urologic Office, Bremerhaven, Germany, 4 Mera Hospital, Moscow, Russia
Objectives To evaluate incidence of prostate cancer in hypogonadal patients with erectile dysfunction, receiving long-acting injectable testosterone undecanoate TU (Nebido®, Bayer-Schering) in comparison with a similar group of controls.
Patients and Methods 154 testosterone deficient patients with average age 57 ± 2.1years with mean follow-up of 30 months (14-37 months), received TU 1000mg and were compared with a control cohort of 160 men (average age 59 ± 1.6 years) with similar characteristics visiting our clinic for preventive medical check up.
TRT patients underwent monitoring protocol at baseline and 3-monthly including assessment of total prostate volume, and ultrasound-guided biopsies when indicated by PSA velocity > 0.75 μg/L per year, or elevation over 4.0 μg/L.
Men visiting our clinic for preventive medical check up were examined assessing the same parameters at yearly intervals.
In all subjects in both groups, no abnormalities on rectal palpation were noted initially.
Results At baseline, hypogonadal patients showed lower PSA values and lower prostate volumes (0.77 vs controls 2.1 μg/L and 27.6 vs control 39.5, respectively).
Patients in group I (hypogonadism and ED) whose PSA velocity on follow up was > 0.75 μg /L above baseline, underwent TRUS-guided prostate biopsy according to protocol (10 cores 1.6 cm each).
In group I (154 hypogonadal), 11 biopsies were performed; finding CaP in 2/11 subjects, both of them unilateral and 5% tumor cells in a core. Gleason score 3+2 and 3+3, respectively. One
patient had a high grade PIN.
In group II 160 control subjects, 12 biopsies were performed. 5 subjects (5/12) showed CaP, 4 of them bilateral, with a higher Gleason score of 3+3 to 4+4 and up to 75% tumor cells in a core.
In group I (hypogonadal), the 2 CaP patients underwent radical retropubic prostatectomy.
In group II, all 5 CaP patients underwent radical retropubic prostatectomy.
1) Subjects with T-deficiency have initially lower prostate volume than eugonadal ones.
2) Subjects with T-deficiency have initially lower PSA levels than eugonadal ones.
3) Appropriate TRT does not increase the incidence of prostate cancer.
4) Smaller and less malignant (better differentiated) tumours were seen in the TRT men.
5) Patients on TRT under close monitoring may benefit as they are more likely to be diagnosed at an early stage.