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Testosterone Replacement, Low T, HCG, & Beyond
Prostate Related Issues
Safety of testosterone therapy in men with prostate cancer
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<blockquote data-quote="madman" data-source="post: 158780" data-attributes="member: 13851"><p><strong><span style="color: rgb(184, 49, 47)">Table 2:</span> Expert recommendations for managing TD in men with active or treated PCa. </strong></p><p></p><p></p><p><strong>Prior to initiating testosterone therapy </strong></p><p></p><p><span style="color: rgb(184, 49, 47)">Candidates for TTh should have a diagnosis of testosterone deficiency based on clinical history and laboratory diagnosis. </span></p><p></p><p><span style="color: rgb(184, 49, 47)">Patients must be made aware that safety data are limited and the degree of risk of PCa progression or recurrence is unknown. </span></p><p></p><p><span style="color: rgb(184, 49, 47)">Confirm there are no medical contraindications (eg, erythrocytosis) to testosterone therapy. </span></p><p></p><p><span style="color: rgb(184, 49, 47)">PSA should be undetectable or <0.1 ng/mL following radical prostatectomy, or stable following radiation treatment. </span></p><p></p><p><span style="color: rgb(184, 49, 47)">The most suitable candidates are those with low-risk disease with apparent cure at least one year following PCa treatment. </span></p><p></p><p><span style="color: rgb(184, 49, 47)">Men with moderate- or high-risk disease, or those on active surveillance should be advised that they are at risk for cancer recurrence or progression, even without TTh. Should recurrence or progression occur, it is unknown to what extent TTh may have contributed to this outcome. </span></p><p></p><p><span style="color: rgb(184, 49, 47)">The clinician should use shared decision-making and obtain informed consent. </span></p><p></p><p><span style="color: rgb(184, 49, 47)">Patients should be advised that PSA may rise with TTh, particularly if baseline serum T is below the saturation point, ie, 250ng/dL. A new PSA plateau will be achieved at 3-6 months. If PSA continues to rise after 6 months, this may indicate disease progression and appropriate investigative steps should be taken.</span></p><p></p><p></p><p></p><p></p><p><strong>Suitable options for testosterone therapy </strong></p><p></p><p><span style="color: rgb(184, 49, 47)">Short-acting formulations are preferred for initial treatment. Longer-acting formulations such as intramuscular testosterone undecanoate or subcutaneous pellets may be considered once PSA is stable.</span></p><p></p><p></p><p></p><p></p><p></p><p><strong>Following initiation of testosterone therapy</strong></p><p></p><p><span style="color: rgb(184, 49, 47)">Measure hematocrit and/or hemoglobin 2–4 times in the 1st year, then at least 1-2 times annually. </span></p><p></p><p><span style="color: rgb(184, 49, 47)">Measure PSA every 3–4 month in the 1st year after initiating testosterone and at least twice a year thereafter. </span></p><p></p><p><span style="color: rgb(184, 49, 47)">Perform DRE 1–2 times within 1st year, then annually. </span></p><p></p><p><span style="color: rgb(184, 49, 47)">Men on active surveillance should undergo prostate biopsy annually for the first two years, and if no progression is noted, may then follow standard AS protocols. </span></p><p></p><p></p><p></p></blockquote><p></p>
[QUOTE="madman, post: 158780, member: 13851"] [B][COLOR=rgb(184, 49, 47)]Table 2:[/COLOR] Expert recommendations for managing TD in men with active or treated PCa. [/B] [B]Prior to initiating testosterone therapy [/B] [COLOR=rgb(184, 49, 47)]Candidates for TTh should have a diagnosis of testosterone deficiency based on clinical history and laboratory diagnosis. [/COLOR] [COLOR=rgb(184, 49, 47)]Patients must be made aware that safety data are limited and the degree of risk of PCa progression or recurrence is unknown. [/COLOR] [COLOR=rgb(184, 49, 47)]Confirm there are no medical contraindications (eg, erythrocytosis) to testosterone therapy. [/COLOR] [COLOR=rgb(184, 49, 47)]PSA should be undetectable or <0.1 ng/mL following radical prostatectomy, or stable following radiation treatment. [/COLOR] [COLOR=rgb(184, 49, 47)]The most suitable candidates are those with low-risk disease with apparent cure at least one year following PCa treatment. [/COLOR] [COLOR=rgb(184, 49, 47)]Men with moderate- or high-risk disease, or those on active surveillance should be advised that they are at risk for cancer recurrence or progression, even without TTh. Should recurrence or progression occur, it is unknown to what extent TTh may have contributed to this outcome. [/COLOR] [COLOR=rgb(184, 49, 47)]The clinician should use shared decision-making and obtain informed consent. [/COLOR] [COLOR=rgb(184, 49, 47)]Patients should be advised that PSA may rise with TTh, particularly if baseline serum T is below the saturation point, ie, 250ng/dL. A new PSA plateau will be achieved at 3-6 months. If PSA continues to rise after 6 months, this may indicate disease progression and appropriate investigative steps should be taken.[/COLOR] [B]Suitable options for testosterone therapy [/B] [COLOR=rgb(184, 49, 47)]Short-acting formulations are preferred for initial treatment. Longer-acting formulations such as intramuscular testosterone undecanoate or subcutaneous pellets may be considered once PSA is stable.[/COLOR] [B]Following initiation of testosterone therapy[/B] [COLOR=rgb(184, 49, 47)]Measure hematocrit and/or hemoglobin 2–4 times in the 1st year, then at least 1-2 times annually. [/COLOR] [COLOR=rgb(184, 49, 47)]Measure PSA every 3–4 month in the 1st year after initiating testosterone and at least twice a year thereafter. [/COLOR] [COLOR=rgb(184, 49, 47)]Perform DRE 1–2 times within 1st year, then annually. [/COLOR] [COLOR=rgb(184, 49, 47)]Men on active surveillance should undergo prostate biopsy annually for the first two years, and if no progression is noted, may then follow standard AS protocols. [/COLOR] [COLOR=rgb(184, 49, 47)] [/COLOR] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Prostate Related Issues
Safety of testosterone therapy in men with prostate cancer
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