title: Testosterone therapy in men with untreated prostate cancer.
abstract: OBJECTIVE
  A history of prostate cancer has been a longstanding contraindication to the use of testosterone therapy due to the belief that higher serum testosterone causes more rapid prostate cancer growth. Recent evidence has called this paradigm into question. In this study we investigate the effect of testosterone therapy in men with untreated prostate cancer.
  
  
  METHODS
  We report the results of prostate biopsies, serum prostate specific antigen and prostate volume in symptomatic testosterone deficient cases receiving testosterone therapy while undergoing active surveillance for prostate cancer.
  
  
  RESULTS
  A total of 13 symptomatic testosterone deficient men with untreated prostate cancer received testosterone therapy for a median of 2.5 years (range 1.0 to 8.1). Mean age was 58.8 years. Gleason score at initial biopsy was 6 in 12 men and 7 in 1. Mean serum concentration of total testosterone increased from 238 to 664 ng/dl (p <0.001). Mean prostate specific antigen did not change with testosterone therapy (5.5 ± 6.4 vs 3.6 ± 2.6 ng/ml, p = 0.29). Prostate volume was unchanged. Mean number of followup biopsies was 2. No cancer was found in 54% of followup biopsies. Biopsies in 2 men suggested upgrading, and subsequent biopsies in 1 and radical prostatectomy in another indicated no progression. No local prostate cancer progression or distant disease was observed.
  
  
  CONCLUSIONS
  Testosterone therapy in men with untreated prostate cancer was not associated with prostate cancer progression in the short to medium term. These results are consistent with the saturation model, ie maximal prostate cancer growth is achieved at low androgen concentrations. The longstanding prohibition against testosterone therapy in men with untreated or low risk prostate cancer or treated prostate cancer without evidence of metastatic or recurrent disease merits reevaluation.
authors.affiliation: Men's Health Boston, Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. amorgent@caregroup.harvard.edu
authors.forename: Abraham
authors.initials: A
authors.lastname: Morgentaler
authors.forename: Larry I
authors.initials: LI
authors.lastname: Lipshultz
authors.forename: Richard
authors.initials: R
authors.lastname: Bennett
authors.forename: Michael
authors.initials: M
authors.lastname: Sweeney
authors.forename: Desiderio
authors.initials: D
authors.lastname: Avila
authors.forename: Mohit
authors.initials: M
authors.lastname: Khera
mesh_terms: D000368:Aged; D000728:Androgens / Q000627:therapeutic use*; D003677:Deficiency Diseases / Q000150:complications / Q000188:drug therapy*; D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000150:complications; D012189:Retrospective Studies; D013739:Testosterone / Q000172:deficiency* / Q000627:therapeutic use*
chemical_list: D000728:Androgens; D013739:Testosterone