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Testosterone Treatment in Men With Prostate Cancer - The Controversy

I have been a proponent of testosterone replacement therapy in men with documented low levels of testosterone. Men with low testosterone present with lethargy, malaise, decrease in libido, erectile dysfunction, falling asleep after meals and loss of muscle mass. The diagnosis is easily made with a blood test, the serum testosterone level, and is easily treated with injections of testosterone or the application of testosterone gels to the skin. The treatment is contraindicated in men with difficulty with urination, untreated obstructive sleep apnea, high blood counts, and in men with prostate cancer.

But now there are a few doctors who question the advice of avoiding testosterone in men who have been successfully treated for prostate cancer. For decades the prevailing treatment for men with prostate cancer that spread beyond the prostate gland was to decrease the testosterone produced by the testicles. This was accomplished by removing the testicles or orchiectomy, or medically castrating the men with drugs that produced castrate levels of testosterone in the blood. Dr. Abraham Morgentaller, a urologist a Beth Israel Deaconess Hospital in Boston, began treating men with prostate cancer, who had symptoms of low testosterone and confirmed by the blood testosterone test, with supplemental testosterone. This was certainly against the previous advice of other urologists.

What is the evidence to support this new approach to testosterone deficiency in men with prostate cancer? Dr. Morgantaler published a report that men who developed prostate cancer had a statistically lower testosterone level than men who were free of prostate cancer. He also started treatment of a select group of men with prostate cancer with testosterone and followed them closely with PSA tests and found that there was no increase in the PSA test but marked improvement in the men’s libido, energy level, and over all quality of life.

So what is a man to do? Talk to your doctor. If your doctor agrees that there may be a roll for testosterone in men with prostate cancer, you can receive therapy with testosterone replacement. In my practice I select men who have zero, or near zero, PSA tests for at least one year after treatment for prostate cancer. They receive testosterone replacement under close scrutiny and must agree to getting a PSA test every month. If the PSA rises, then they must agree to discontinue the testosterone replacement therapy. For more information, see these articles:

What Is Psa, and How Do We Measure It?

Prostate-Specific Antigen (PSA) Testing for Prostate Cancer

Prostate Specific Antigen (PSA) Explanation

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Reprinted with permission from Neil Baum, neilbaum.com

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