Two years of testosterone therapy associated with decline in prostate-specific antigen in a man with untreated prostate cancer.
BACKGROUND
Testosterone (T) therapy has long been considered contraindicated in men with prostate cancer (PCa). However, the traditional view regarding the relationship of T to PCa has come under new scrutiny, with recent reports suggesting that PCa growth may not be greatly affected by variations in serum T within the near-physiologic range.


OBJECTIVE
This report details the clinical and prostate-specific antigen (PSA) response of a man with untreated PCa treated with T therapy for 2 years.


METHODS
Measurements of serum PSA, total and free T concentrations were obtained at regular intervals at baseline and following initiation of T therapy.


METHODS
Serum PSA during T therapy.


RESULTS
An 84-year-old man was seen for symptoms of hypogonadism, with serum total T within the normal range at 400 ng/dL, but with a reduced free T of 7.4 pg/mL (radioimmunoassay [RIA], reference range 10.0-55.0). PSA was 8.5 ng/mL, and 8.1 ng/mL when repeated. Prostate biopsy revealed Gleason 6 cancer in both lobes. He refused treatment for PCa, but requested T therapy, which was initiated with T gel after informed consent regarding possible cancer progression. Serum T increased to a mean value of 699 ng/dL and free T to 17.1 pg/mL. PSA declined to a nadir of 5.2 ng/mL at 10 months, increased slightly to 6.2 ng/mL at 21 months, and then declined to 3.8 ng/mL at 24 months after addition of dutasteride for voiding symptoms. No clinical PCa progression was noted.


CONCLUSIONS
A decline in PSA was noted in a man with untreated PCa who received T therapy for 2 years. This case provides support for the notion that PCa growth may not be adversely affected by changes in serum T beyond the castrate or near-castrate range.
Morgentaler
Abraham
A
Harvard Medical School, Urology, Brookline, MA, USA. amorgent@yahoo.com
D000369:Aged, 80 and over; D001706:Biopsy; D018450:Disease Progression; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000150:complications* / Q000473:pathology; D012720:Severity of Illness Index; D013739:Testosterone / Q000008:administration & dosage / Q000627:therapeutic use*
D013739:Testosterone; D017430:Prostate-Specific Antigen