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Use of Testosterone Therapy in Patients With Prostate Cancer

What is hypogonadism?

Testosterone is the male hormone which is mainly produced by the testis. Small quantities are made in other organs (eg adrenal gland), but in a man this contributes only a small amount of the total. Testosterone is a hormone which is released into the blood which will have effects on other parts of the body. When men have a lack of testosterone the condition is termed hypogonadism.

What are the symptoms of hypogonadism?

The symptoms of hypogonadism include loss of libido or reduced interest in sexual activity, erectile dysfunction or ED, reduced facial hair, loss of energy, falling asleep after meals, reduced muscle power and stamina, loss of height, and osteoporosis or brittle bones which may result in fractures of the spine or hips.

How is hypogonadism diagnosed?

The diagnosis is made on the basis of the clinical symptoms described above and confirmed with a blood test measuring the testosterone level.

What is the relationship between prostate cancer and testosterone?

It has been known since the 1940's that severe reductions of testosterone can cause shrinkage of prostate cancer that has spread to the bones, and therefore there has been a concern that raising testosterone levels might cause growth of any hidden prostate cancers. However, a recent study from Harvard has found no connection between higher testosterone levels and prostate cancer, nor did the study find evidence that testosterone treatment causes prostate cancer.

In fact, studies have demonstrated no difference in prostate cancer incidence among hypogonadal men using testosterone therapy compared to men in the general population.

Can I take testosterone if I have prostate cancer?

Historically, men have been told to avoid testosterone if they have prostate cancer just as women with breast cancer have been told to avoid using estrogens or the female hormone produced by the ovaries. However, if a man who has had a radical prostatectomy or radiation therapy and the PSA remains at the undetectable level after surgery or stable for 24-36 months after radiation, then he might be a candidate for testosterone replacement therapy if he is symptomatic for hypogonadism and he has a decreased testosterone level.

What precautions must I take if I use testosterone and I have a diagnosis of prostate cancer?

It is necessary for regular intervals for monitoring of PSA and exams.
If the PSA rises, then the testosterone must be discontinued.

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This form is an acknowledgment that I understand and agree to the use of testosterone treatments. I understand that testosterone, either by injection, absorbable patch, or gel or pill, is being given electively and can be stopped at any time because of side effects or reactions to the medication.

The goal of testosterone replacement therapy is to raise the level of testosterone in my body. I understand that my body is not producing enough testosterone and this may decrease my sexual performance, decrease my energy level, muscle strength, and bone strength.

I acknowledge that no guarantees or warranties have been made implicitly regarding the curability of my situation, or that my sexual performance or sexual desire will improve with the use of this drug or any other drug. I understand that male hormones including testosterone have potential side effects and risks. These include a small chance of allergic reactions. Some types of male hormones (such as methyltestosterone) have been reported to cause liver problems including hepatitis and tumors. Testosterone is not known to cause these effects. Some patients note swelling of the legs (edema) which might require water pills (diuretics) to treat. Some patients develop slight enlargement or tenderness of one or both breasts. Snoring or sleep apnea may get worse.

Patients taking anti-coagulants (Coumadin), insulin or the anti-inflammatory drug Oxyphenbutazone might need dose changes and this should be brought to the attention of my regular medical doctor.

I understand that I must return to the doctor's office on a regular basis to monitor the PSA level and if the PSA level increases than I understand that the testosterone needs to be discontinued. I understand that the medication needs to be given by injection which is given every one to four weeks, by a daily gel applied to the skin or by a patch that is replaced on a daily basis.

I understand that I will also need to have periodic blood tests to check my liver function, my cholesterol, and my blood count or hemoglobin level.

I understand the risks and side effects and complications and intended treatment outcome and alternative therapies for my problem and consent to its use.

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Patient		Date
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Witness

Reprinted with permission from Dialog Medical, dialogmedical.com

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