Rising PSA during Testosterone Replacement TherapyThe aging process is a reality that all men must face. It is estimated that 1 in 7 men suffer from hypogonadism or decreased testosterone production. Testosterone replacement has been promoted in the literature as the panacea for hypertension, lethargy, depression, obesity, insulin resistance, cognitive function, sexual dysfunction and various other disease states. Paradoxically, the majority of men who would benefit most from testosterone are over 50 years old; an age where testosterone replacement therapy and psa levels risk of prostate cancer is increasingly significant. Statistics show that one in six men will get prostate cancer tgerapy their lifetime while test prop nandrolone phenylpropionate most prevalent decade for the diagnosis of prostate cancer is the seventh decade of life or men in their 60s. While testosterone has never been proven to cause prostate cancer, it is well accepted that this prominent male hormone testosterone replacement therapy and psa levels prostate cancer to grow. According to the American Cancer Society, approximatelymen are diagnosed with levelss cancer yearly.
Is Testosterone Treatment Good for the Prostate? Study of Safety During Long-Term Treatment | ISSM
The aging process is a reality that all men must face. It is estimated that 1 in 7 men suffer from hypogonadism or decreased testosterone production. Testosterone replacement has been promoted in the literature as the panacea for hypertension, lethargy, depression, obesity, insulin resistance, cognitive function, sexual dysfunction and various other disease states. Paradoxically, the majority of men who would benefit most from testosterone are over 50 years old; an age where the risk of prostate cancer is increasingly significant.
Statistics show that one in six men will get prostate cancer in their lifetime while the most prevalent decade for the diagnosis of prostate cancer is the seventh decade of life or men in their 60s. While testosterone has never been proven to cause prostate cancer, it is well accepted that this prominent male hormone causes prostate cancer to grow,. According to the American Cancer Society, approximately , men are diagnosed with prostate cancer yearly.
According to the Surveillance, Epidemiology and End-Results SEER Data more than , men are projected to be diagnosed with prostate cancer yearly within the next years. While low testosterone levels are significant in an aging population, prostate cancer is the number one risk factor that men face from a health standpoint.
PSA prostate specific antigen , a blood test, has been shown to be the best singular marker to prove the presence of prostate disease, albeit, it is non-specific for the diagnosis of prostate cancer.
Notwithstanding this commentary, men with a PSA value of 1. A reasonable PSA level under which men could confidently consider supplementation or replacement with testosterone is a number less than 2. Not inconsistent with my beliefs, the Society of Endocrinology recommends avoidance of testosterone usage when the PSA number is 3. Similarly, men should not supplement or replace with testosterone when there is a family history of prostate cancer or if the PSA number has increased by 0.
An exception would be made if a Urologist has ruled out prostate cancer. Unfortunately, the most common method to rule out prostate cancer when the PSA is 2. Historically, biopsy has been thought to be a relatively innocuous procedure associated with acceptable, albeit, temporary side effects like bleeding into the bowel, urinary tract and seminal fluid as well as the possibility of additional clinical conditions like infection, sepsis and sexual dysfunction.
While the public has been led to believe that biopsies are a reasonable solution to a rising PSA, an extensive search of the literature, exposes a more sinister and compelling reason to avoid a biopsy unless certain precautions are met and the procedure is deemed absolutely necessary.
This is a significant issue, whereby cells escape the prostate during a procedure, when a biopsy needle encounters prostate cancer cells in its path. In addition to intensifying inflammation as a root cause of prostate cancer, needle tracking or seeding of prostate cancer cells beyond the prostate capsule has been identified in the Perineum the space between the scrotum and the rectum as well as in the rectal wall.
Prostate biopsy in the traditional format is a crude diagnostic technique, if not an unacceptable means, to evaluate for prostate cancer based on inherent sampling bias and needle tracking. Sampling bias is associated with the uncertainty for what the biopsy needle will yield as a physician sticks a needle after needle randomly into a prostate up to 90 times when a mapping procedure is performed in anticipation of treating prostate cancer definitively.
A much more sophisticated technology is now available with either a 1. This technology represents the most sensitive and specific diagnostic modality for the prostate, replacing substandard scanning procedures like PET Positron Emitting Tomography , CAT scan and Prostascint scans. The MRI scan creates a virtual road map enabling an evaluation of the entire organ, subsequently allowing for a determination to be made regarding the presence or absence of prostate cancer.
In the event, an image indicates the presence of prostate cancer; a targeted biopsy can be performed while using a specific protocol to prevent cells that escape from proliferating. When a multi-parametric MRI evaluation identifies a localized area of interest that proves to be consistent with the presence of prostate cancer, a decision can be made to treat the disease conservatively with a Chronic Disease Management Protocol, referencing a peer reviewed study published in the Journal, Clinical Interventions in Aging or provide the road map for a focal therapy using either cryosurgery or high intensity focused ultrasound HIFU.
Based on our findings, we believe that the future diagnostic landscape will feature a prostate biopsy, only when preceded by an MRI scan to isolate a region of interest. This paradigm shift in how men qualify for a biopsy will become the new standard of care, allowing men with no evidence of prostate cancer to avoid an unnecessary procedure while treating prostatitis only. Even if doctors choose not to embrace or understand the advantage of this exceptional technology, patients will demand a change in the diagnostic model as it is the patient who is asked to bear the scars of professional ignorance.
With image guided targeted biopsies, the guessing game is over as no more than 6 selective biopsies validate the presence or absence of cancer. To date, many men have been diagnosed with prostate cancer, stimulated by Testosterone. A recent case of a 51 year old male with an interest in testosterone replacement illustrates the benefits of the multi-parametric prostate MRI scan.
Noting a PSA value of only 2. Neither the gray scale ultrasound nor Color Flow Doppler ultrasound evaluation suggested any specific abnormality consistent with the area of interest previously identified on DRE. An MRI scan was suggested as the next best step in the evaluation. The scan isolated a region of interest on the left side at the Apex to Middle portion of the prostate gland concordant with the findings on the DRE.
Based upon the findings of the MRI scan, a targeted biopsy with 6 needle cores was recommended and implemented. Specifically, an Antiandrogen selectively blocks the receptor on the prostate cell from attracting testosterone as it exits the capsule, thereby, disabling the cells in preparation for cell death or apoptosis. The Pathology evaluation revealed a grade of cancer that was amenable to being treated conservatively or focally.
In this case, the failure to use a MRI scan would have exposed this patient to the possibility of missing the cancer altogether; associated with sampling bias, a very real possibility for needle tracking assuming cancer was found , or worse yet, the go ahead to supplement with testosterone, when in fact, the cancer was missed.
Given the expertise of a Urolologic consultation, this case turned out well. The patient is now contemplating a focal treatment with high intensity focused ultrasound with a plan to supplement with testosterone once his cancer has been cured.
While studies have shown healthier men require testosterone replacement less frequently than diseased men, there is nonetheless, a generation of men who will want to try to turn back the hands of time. In men with a PSA greater than 2. The toll free number to call to schedule a Free Consultation is By doing so, an individual may avoid becoming a statistic of ignorance. Prostate cancer in men using testosterone supplementation. Understanding the role of prostate inflammation resolution to prostate cancer evolution.
J Clin Interventions in Aging, 2 1: Role of diet in prostate cancer development and progression. J Clin Oncol, The Johns Hopkins White Paper. The role of inflammation in the pathogenesis of prostate cancer.
Intensive lifestyle changes may affect the progression of prostate cancer. American Association of Clinical Endocrinologists. Medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients.
Dramatic rise in prostate specific antigen after androgen replacement in a hypogonadal man with occult adenocarcinoma of the prostate. Prevalence of hypogonadism in males aged at least.
Prostate cancer after exogenous testosterone treatment for impotence. Occult prostate cancer in men with low serum testosterone levels. Risks of testosterone replacement therapy and recommendations for monitoring.
N Engl J Med, Managing the risks of prostate disease during testosterone replacement therapy in older men: Institute of Medicine of the National Academies Press, Nutrition Testosterone Replacement Therapy. Diagnostic Center for Disease Main St. While testosterone has never been proven to cause prostate cancer, it is well accepted that this prominent male hormone causes prostate cancer to grow, when present. Johns Hopkins, P 28, 6. Prevalence of hypogonadism in males aged at least 45 years: Int J Clin Pract, 60 7: