madman
Super Moderator
Abstract
Introduction
A high prevalence of low testosterone levels has been reported in men with prostate cancer. The use of testosterone therapy in men with a history of prostate cancer is still controversial, and there is uncertainty regarding the management of these patients.
Methods
We analyzed the European and American guidelines on this topic and presented our clinical experience in the management of patients with low testosterone levels and a history of prostate cancer in one of the world’s leading cancer centers.
Results
According to the published evidence to date, testosterone therapy in men with prostate cancer does not increase the risk of prostate cancer recurrence in the short and medium term, but there is a lack of data on the long term. Symptomatic men with low testosterone levels who are candidates for this therapy need a thorough clinical evaluation before commencing testosterone therapy. Evaluation of prostate cancer history including the type of treatment administered, pathologic stage of prostate cancer, and prostate-specific antigen should be requested before and during testosterone treatment to assess its trend.
Conclusion
Prostate-specific antigen should remain undetectable after radical prostatectomy or stable after radiotherapy. Otherwise, it would be a sign of uncontrolled prostate cancer, and the patient may require cessation of testosterone therapy and referral to oncology for further evaluation.
*Testosterone therapy: evaluation prior to initiation of treatment
*Prostate cancer and baseline PSA
*Testosterone and PSA levels in the follow-up of prostate cancer patients
Conclusion
In our clinical practice, we believe that patients with a history of prostate cancer need a thorough evaluation and require extensive counseling on risks and benefits. To date, published evidence on prostate cancer patients has not shown that testosterone therapy is associated with an increased risk of prostate cancer recurrence in the short and medium term, but there is a lack of evidence in the long term. Men with low testosterone levels combined with symptoms who meet the criteria for testosterone deficiency and are candidates for this therapy require adequate and comprehensive clinical evaluation prior to initiation of treatment. This is important to select those prostate cancer patients who will safely benefit from treatment. In men with a history of prostate cancer, evaluation of (i) the type of treatment performed, (ii) determination of the pathologic stage of prostate cancer and (i) the baseline PSA and its trend prior to initiation of testosterone therapy is mandatory. Based on PSA, patients would be candidates for initiation of testosterone therapy if PSA levels remain undetectable after radical prostate surgery or stable and at minimal values after radiotherapy.
Subsequent PSA monitoring after initiation of testosterone therapy is imperative. PSA should remain undetectable after radical prostate surgery or stable after radiotherapy. Otherwise, it means that prostate cancer is not controlled, and the patient would require cessation of testosterone therapy and referral to oncology for further evaluation.
Introduction
A high prevalence of low testosterone levels has been reported in men with prostate cancer. The use of testosterone therapy in men with a history of prostate cancer is still controversial, and there is uncertainty regarding the management of these patients.
Methods
We analyzed the European and American guidelines on this topic and presented our clinical experience in the management of patients with low testosterone levels and a history of prostate cancer in one of the world’s leading cancer centers.
Results
According to the published evidence to date, testosterone therapy in men with prostate cancer does not increase the risk of prostate cancer recurrence in the short and medium term, but there is a lack of data on the long term. Symptomatic men with low testosterone levels who are candidates for this therapy need a thorough clinical evaluation before commencing testosterone therapy. Evaluation of prostate cancer history including the type of treatment administered, pathologic stage of prostate cancer, and prostate-specific antigen should be requested before and during testosterone treatment to assess its trend.
Conclusion
Prostate-specific antigen should remain undetectable after radical prostatectomy or stable after radiotherapy. Otherwise, it would be a sign of uncontrolled prostate cancer, and the patient may require cessation of testosterone therapy and referral to oncology for further evaluation.
*Testosterone therapy: evaluation prior to initiation of treatment
*Prostate cancer and baseline PSA
*Testosterone and PSA levels in the follow-up of prostate cancer patients
Conclusion
In our clinical practice, we believe that patients with a history of prostate cancer need a thorough evaluation and require extensive counseling on risks and benefits. To date, published evidence on prostate cancer patients has not shown that testosterone therapy is associated with an increased risk of prostate cancer recurrence in the short and medium term, but there is a lack of evidence in the long term. Men with low testosterone levels combined with symptoms who meet the criteria for testosterone deficiency and are candidates for this therapy require adequate and comprehensive clinical evaluation prior to initiation of treatment. This is important to select those prostate cancer patients who will safely benefit from treatment. In men with a history of prostate cancer, evaluation of (i) the type of treatment performed, (ii) determination of the pathologic stage of prostate cancer and (i) the baseline PSA and its trend prior to initiation of testosterone therapy is mandatory. Based on PSA, patients would be candidates for initiation of testosterone therapy if PSA levels remain undetectable after radical prostate surgery or stable and at minimal values after radiotherapy.
Subsequent PSA monitoring after initiation of testosterone therapy is imperative. PSA should remain undetectable after radical prostate surgery or stable after radiotherapy. Otherwise, it means that prostate cancer is not controlled, and the patient would require cessation of testosterone therapy and referral to oncology for further evaluation.
