Prostate specific antigen (PSA) has replaced serum acid phosphatase as the laboratory test of choice in prostate cancer for improved sensitivity and specificity. Men undergoing surgical or medical castration experience dramatic decrease in PSA and, in most cases, clinical disease regression.
Full Answer
Should testosterone therapy be used to treat prostate cancer?
*Editor’s note: Dr. Thompson has received support from a company that makes drugs that affect testosterone levels in the prostate and a company that makes diagnostic tests for prostate cancer. The oldest and most strongly held prohibition against testosterone therapy is its use in men previously diagnosed with prostate cancer.
Where can I find information about hormone therapy for prostate cancer?
Call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) for information about clinical trials of hormone therapy for prostate cancer. Massie CE, Lynch A, Ramos-Montoya A, et al. The androgen receptor fuels prostate cancer by regulating central metabolism and biosynthesis.
What is hormone therapy for testicular cancer?
This form of hormone therapy (also called androgen deprivation therapy, or ADT) includes: Orchiectomy, a surgical procedure to remove one or both testicles.
Is low free and bioavailable testosterone associated with prostate cancer?
Léon et al [43] found that low free and bioavailable testosterone levels were associated with high-grade prostate cancer at radical prostatectomy [43], although the consistency and clinical significance of these findings remain to be seen. 3.5. Testosterone therapy in men treated for prostate cancer
What should testosterone levels be with prostate cancer?
Pertinent clinical guidelines at the bottom of the report to state that “international guidelines recommend a serum testosterone level to be at least <0.7 nmol/L7or <1 nmol/L in the setting of androgen deprivation for prostate cancer”.
What is the name of the hormone shot for prostate cancer?
Lupron is the brand name for leuprolide acetate. This drug is a type of hormone therapy that doctors typically use in combination with other treatments to treat people with prostate cancer. Lupron belongs to a class of drugs called luteinizing hormone-releasing hormone (LHRH) agonists.
Is PSA a measure of testosterone?
The scientists found that men who had higher testosterone levels also had higher PSA levels. "We also found that the odds of having a clinically elevated PSA were greater among men with higher testosterone levels.
Is testosterone and PSA the same?
Prostate-specific antigen (PSA) secretion is a testosterone (T) dependent process. Published data suggest that a low T level is an independent predictor of higher-grade prostate cancer (PC).
What is the difference between Lupron and Eligard?
Eligard and Lupron Depot both contain the same active ingredient — leuprolide. They both lower testosterone levels and are used for advanced prostate cancer. Eligard is given as an injection under the skin. Lupron Depot is given as an injection in a muscle.
What are the two most common hormones used for prostate cancer?
The most abundant androgens in men are testosterone and dihydrotestosterone (DHT). Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make semen. Androgens are also necessary for prostate cancers to grow.
Does low PSA mean low testosterone?
The study found men with low PSA have significantly higher rates of low testosterone -- also known as hypogonadism, and low growth hormone status compared with those with normal PSA.
How much does testosterone raise your PSA?
Averaging several investigations of the effect of TRT on PSA, men receiving testosterone will have an associated increase of 0.30 ng/mL/y in serum PSA, with older men experiencing a greater increase of 0.43 ng/mL/y.
What is testosterone blood test?
A testosterone test measures the blood level of the male sex hormone testosterone. Testosterone, which plays an important role in sexual development, is produced mainly by the testes in boys and in much smaller amounts by the ovaries in girls. Testosterone is also produced by the adrenal glands in both girls and boys.
Can taking testosterone make your PSA go up?
Testosterone therapy often increases serum prostate-specific antigen (PSA) levels, which in turn may lead to urological referral, prostate biopsy, and detection of prostate cancer.
Does testosterone replace PSA?
Testosterone replacement therapy does not increase PSA levels in men being treated for hypogonadism, except when it is given IM and even the increase with IM administration is minimal.
Can testosterone injections elevated PSA?
Patients treated with testosterone tended to have higher PSA levels, and thus a greater change than those that received control treatments (difference in means of PSA levels = 0.154, 95% confidence interval [CI] 0.069 to 0.238, P < 0.001).
Is testosterone therapy contraindicated?
Introduction: Although testosterone therapy (TTh) is the standard practice in otherwise healthy hypogonadal men, this therapy has historically been contraindicated in men with a history of prostat e cancer . Recent evidence suggests that there is minimal or no prostate cancer growth in the setting of TTh administration in men definitively treated ...
Is bipolar androgen deprivation effective?
More recent research has begun to elucidate the effectiveness of bipolar androgen deprivation therapy in the treatment of prostate cancer . This mechanism of action increases the level of evidence indicating that the traditional management of maintaining testosterone levels at low levels may no longer be standard of care.
What is the best treatment for metastatic prostate cancer?
Largely based on these studies, surgical castration (bilateral orchiectomy) became the mainstay of treatment for men with metastatic prostate cancer for decades. Medical castration through androgen deprivation therapy (ADT) has largely supplanted bilateral orchiectomy; although the efficacy of both modalities is undisputed. Prostate specific antigen (PSA) has replaced serum acid phosphatase as the laboratory test of choice in prostate cancer for improved sensitivity and specificity. Men undergoing surgical or medical castration experience dramatic decrease in PSA and, in most cases, clinical disease regression. The positive experiences with ADT, Huggins' Nobel-prize winning work, and some anecdotal case reports, combined to create an axiomatic belief that exogenous androgen is contraindicated in men with prostate cancer. That belief has been largely unchallenged for 7 decades.
What is the role of androgens in prostate cancer?
These assumptions date back to the 1940s and can be traced to the work of Charles Huggins. One of only two urologists that have been awarded a Nobel Prize, Huggins and Hodges' work described the role of androgens in prostate cancer progression [9]. Their research in men with metastatic prostate cancer established the androgen hypothesis—that prostate cancer development and growth is directly related to the degree of androgenic activity in the body. Their conclusion that cancer of the prostate is “activated” by androgens gave rise to the belief that raising serum androgens via the administration of exogenous testosterone to men with prostate cancer would necessarily promote malignant cell growth and disease progression [9].
What is the saturation point of testosterone?
Empirically, the saturation point at which there is no further appreciable growth with increasing serum T concentration appears to be at approximately 240–250 ng/dl, consistent with predicted values based on maximal androgen receptor binding to androgen. In the TRiUS registry, men with baseline serum T concentrations greater than 250 ng/dl did not demonstrate a rise in PSA [29]. Similarly, in a 6-mo prospective, placebo-controlled testosterone gel study, an increase in PSA was seen in men with baseline T < 250 ng/dl, but not in men with baseline T > 250 ng/dl [30]. Finally, Rastrelli et al [31] showed a naturally occurring saturation curve (Fig. 1) for PSA in 2967 men with a nearly identical saturation point of 8 nmol/l (approximately 240 ng/dl).
Does testosterone increase prostate cancer?
The historical notion that increasing testosterone was responsible for prostate cancer growth was based on elegant yet limited studies from the 1940s and anecdotal case reports. Current evidence reveals that high endogenous androgen levels do not increase the risk of a prostate cancer diagnosis. Similarly, testosterone therapy in men with testosterone deficiency does not appear to increase prostate cancer risk or the likelihood of a more aggressive disease at prostate cancer diagnosis. Androgen receptor saturation (the saturation model) appears to account for this phenomenon. Men who received testosterone therapy after treatment for localized prostate cancer do not appear to suffer higher rates of recurrence or worse outcomes; although studies to date are limited. Early reports of men on active surveillance/watchful waiting treated with testosterone have not identified adverse progression events.
Is testosterone therapy contraindicated for prostate cancer?
The use of testosterone therapy in men with prostate cancer was previously contraindicated, although recent data challenge this axiom. Over the past 2 decades, there has been a dramatic paradigm shift in beliefs, attitude, and treatment of testosterone deficiency in men with prostate cancer.
Does androgen cause prostate cancer?
Higher endogenous serum androgen concentrations are not associated with increased risk of developing prostate cancer, or severity of prostate cancer [32,33]
What fish can you eat to prevent prostate cancer?
Add fish to your weekly meals. The healthy omega-3 fatty acids found in fish like salmon and tuna have been linked to a reduced risk for prostate cancer.
What to do if you have low testosterone?
If you have low testosterone and it’s affecting your quality of life, talk to your doctor. Discuss the benefits and risks of hormone therapy , especially if you have a history of prostate cancer. Last medically reviewed on October 30, 2017.
What is the median age for prostate cancer?
Age. Your risk for prostate cancer rises the older you get. The median age of diagnosis is 66, with the majority of diagnoses occurring in men between the ages of 65 and 74.
When did testosterone stop growing?
In the early 1940s. Trusted Source. , researchers Charles Brenton Huggins and Clarence Hodges discovered that when men’s testosterone production dropped, their prostate cancer stopped growing. The researchers also found that giving testosterone to men with prostate cancer made their cancer grow. They concluded that testosterone promotes prostate ...
How many men are affected by hypogonadism?
Hypogonadism affects an estimated 2.4 million men over age 40 in the United States. By their 70s, one-quarter of men will have this condition.
Does testosterone increase prostate cancer risk?
Trusted Source. of research found no relationship between a man’s testosterone level and his risk of developing prostate cancer. Another review of studies showed that testosterone therapy doesn’t increase the risk of prostate cancer or make it more severe in men who have already been diagnosed. According to a 2015 review.
Which race is more likely to get prostate cancer?
Race. African-American men are more likely to get prostate cancer and to have more aggressive tumors than white or Hispanic men. Diet. A high-fat, high-carbohydrate, and highly processed diet may increase your risk for prostate cancer.
What types of hormone therapy are used for prostate cancer?
Hormone therapy for prostate cancer can block the production or use of androgens ( 4 ). Currently available treatments can do so in several ways:
How is hormone therapy used to treat hormone-sensitive prostate cancer?
Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer , including:
How is castration-resistant prostate cancer treated?
Complete androgen blockade —that is, androgen receptor blockers ( flutamide, bicalutamide, nilutamide, apalutamide, darolutamide, or enzalutamide ).
What can be done to reduce the side effects of hormone therapy for prostate cancer?
Men who lose bone mass during long-term hormone therapy may be prescribed drugs to slow or reverse this loss. The drugs zoledronic acid (Zometa) and alendronate (Fosamax) (both of which belong to a class of drugs called bisphosphonates) can be used to increase bone mineral density in men who are undergoing hormone therapy ( 29, 30 ), as can a newer drug, denosumab (Prolia), which increases bone mass through a different mechanism ( 31 ). However, drugs to treat bone loss are associated with a rare but serious side effect called osteonecrosis of the jaw ( 20 ).
What are male sex hormones?
Hormones are substances that are made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs.
What hormones inhibit prostate cancer?
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
What are the two things that are needed for prostate cancer?
Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells ( 1 ). Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells ...
Why does prostate cancer grow?
The course of prostate cancer growth, like breast cancer growth [is] due to the continued presence of an underlying metabolic imbalance. The underlying metabolic imbalance in all hormone-dependent cancers is estrogen dominance. Prevent the estrogen dominance and you will prevent the cancer.
What are the symptoms of low testosterone?
These include reduced sex drive and sense of vitality, erectile dysfunction, decreased energy, lower muscle mass and bone density, and anemia. When severe, these signs and symptoms characterize a condition called hypogonadism.
Why do doctors love to see the PSA go down?
why do doctors love to see the PSA go down? Well, it’s because they are confused. They know that higher PSA scores tend to correlate with more cancer and lower PSA scores tend to correlate with less cancer. But they don’t understand the crowding issue or how the PSA compound itself helps fight prostate cancer. So they mistakenly think that lowering the PSA count means they are reducing the cancer. Conventional doctors today use drugs like Lupron or Casodex, which are very effective at lowering the production of PSA in the body and a subsequent lowering of PSA scores. However, by lowering the PSA artificially with hormone-blocking drugs, doctors may actually be promoting the growth of the cancer.
What are the side effects of prostate cancer?
Prostate cancer treatment often results in fatigue, depression, isolation and sometimes suicide. Billions of dollars are profited from ED drug and other ED products, catheters, pads and diapers, drugs for depression or pain or insomnia or incontinence, additional treatments and surgeries for side effects.
What percentage of black men have a prescription filled for an infection after a biopsy?
60% had a prescription filled for an infection after a Biopsy. Black men are at an increased risk of prostate cancer. Prostate cancer patients are at an increased risk for fatigue, depression, suicide and heart attacks. Excuse the generally accurate humor and sarcasm.
Does testosterone cause prostate cancer?
One of the most heated debates centers on whether testosterone fuels prostate cancer. If that’s true, say some experts, then why do men develop prostate cancer when they are older, at the same time their testosterone levels are dropping? (See Figure 1.) Others point to the fact that many men with prostate cancer, especially those with advanced or metastatic cancers, take hormone therapy that nearly stops the production of testosterone to tamp down the disease. Under the influence of hormone therapy, tumors regress. So wouldn’t the opposite be true — that giving a man testosterone will accelerate or promote tumor growth?
How many men are affected by hypogonadism?
When severe, these signs and symptoms characterize a condition called hypogonadism. Researchers estimate that hypogonadism affects two to six million men in the United States. Yet it is an underdiagnosed problem, with only about 5% of those affected receiving treatment, according to the FDA.
What is the technical term for testosterone replacement?
The biggest concern from testosterone replacement therapy is the development of red blood cell counts that are higher than normal—the technical term is a high hematocrit . The hematocrit, often abbreviated as Hct, is a component of a blood panel, the CBC or complete blood count.
How many types of prostate cancer are there?
Active prostate cancer basically can be divided into two broad categories—the harmless types (in particular, those that are determined to be of a grade of six or less as determined through a needle biopsy or by surgery), and the more consequential types, which are graded from seven through ten.
Can testosterone be given to men with prostate cancer?
Now let’s discuss the situations where giving testosterone therapy might be acceptable in a man with known prostate cancer. The first situation is giving testosterone to men with low grade or benign tumors. Certain types of prostate cancer are so low grade they are essentially harmless. These types of prostate cancer never spread ...
Can you take testosterone if you have prostate cancer?
The answer is a qualified “yes,” but there are at least four situations with exceptions that will be addressed below. However, before we describe the situations in which men with prostate cancer can consider taking testosterone, we need to discuss how blood tests that measure testosterone are interpreted.
Can testosterone therapy be stopped?
If these tests indicate that the cancer is progressing unduly quickly, the testosterone therapy can be stopped with the expectation that cancer will stop progressing or even regress after the testosterone is stopped.
Is testosterone safe for men?
The second situation where giving testosterone might be reasonably safe is when men have previously undergone therapy with surgery or radiation and appear to be cured. After an appropriate waiting period of somewhere between two and five years, the risk of cancer recurrence is generally quite low.
Is it safe to give testosterone?
Studies have shown that giving testosterone is not totally safe— even in men that don’t have any prostate cancer whatsoever. Testosterone levels in the blood tend to decrease with age. Most men adapt to these modest reductions in testosterone without experiencing undue difficulty.
What are the drugs that help prostate cancer grow?
Anti-androgens. For most prostate cancer cells to grow, androgens have to attach to a protein in the prostate cancer cell called an androgen receptor. Anti-androgens are drugs that also connect to these receptors, keeping the androgens from causing tumor growth.
What hormones are used to remove testicles?
Estrogens (female hormones) were once the main alternative to removing the testicles (orchiectomy) for men with advanced prostate cancer. Because of their possible side effects (including blood clots and breast enlargement), estrogens have been replaced by other types of hormone therapy.
How does LHRH affect prostate cancer?
Men whose cancer has spread to the bones may have bone pain. Men whose prostate gland has not been removed may have trouble urinating . If the cancer has spread to the spine, even a short-term increase in tumor growth as a result of the flare could press on the spinal cord and cause pain or paralysis. A flare can be avoided by giving drugs called anti-androgens (discussed below) for a few weeks when starting treatment with LHRH agonists.
What is the goal of hormone therapy?
The goal is to reduce levels of male hormones, called androgens, in the body, or to stop them from fueling prostate cancer cells. Androgens stimulate prostate cancer cells to grow. The main androgens in the body are testosterone ...
Where is androgen made?
Most androgen is made by the testicles, but the adrenal glands (glands that sit above your kidneys) as well as the prostate cancer itself, can also make a fair amount. Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time.
Can prostate cancer cause pain in the spine?
Men whose cancer has spread to the bones may have bone pain. Men whose prostate gland has not been removed may have trouble urinating. If the cancer has spread to the spine, even a short-term increase in tumor growth as a result of the flare could press on the spinal cord and cause pain or paralysis.
Is prostate cancer permanent?
It is probably the least expensive and simplest form of hormone therapy. But unlike some of the other treatments, it is permanent, and many men have trouble accepting the remo val of their testicles.