LOWER PROSTATE CANCER INCIDENCE, SIZE AND GRADE ON APPROPRIATE MONITORED TESTOSTERONE REPLACEMENT:

 

Further to the discussion  last week: on myths and realities of prostate cancer risk with appropriate hormone replacement HRT – testosterone replacement TRT,

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.

 

Conclusions

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.

 

 

 

 

 

 

 

 

 

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