title: Challenges to treat hypogonadism in prostate cancer patients: implications for endocrinologists, urologists and radiotherapists.
abstract: The literature suggests that the serum testosterone level required for maximum androgen receptor (AR) binding may be in the range of nanomolar and above this range of concentrations; this sexual hormone may not significantly affect tumour biology. This assumption is supported by clinical studies showing that cell proliferation markers did not change when serum T levels increased after exogenous T treatment in comparison to subjects treated with placebo. However, a considerable part of the global scientific community remains sceptical regarding the use of testosterone replacement therapy (TRT) in men suffering from hypogonadism and prostate cancer (Pca). The negative attitudes with respect to testosterone supplementation in men with hypogonadism and Pca may be justified by the relatively low number of clinical and preclinical studies that specifically dealt with how androgens affect Pca biology. More controversial still is the use of TRT in men in active surveillance or at intermediate or high risk of recurrence and treated by curative radiotherapy. In these clinical scenarios, clinicians should be aware that safety data regarding TRT are scanty limiting our ability to draw definitive conclusions on this important topic. In this review we critically discuss the newest scientific evidence concerning the new challenges in the treatment of men with hypogonadal condition and Pca providing new insights in the pharmacological and psychological approaches.
authors.affiliation: 1 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy ; 2 Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy ; 3 Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy ; 4 Department of Systems Medicine, Tor Vergata University of Rome, 00131 Roma, Italy.
authors.forename: Giovanni L
authors.initials: GL
authors.lastname: Gravina
authors.affiliation: 1 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy ; 2 Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy ; 3 Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy ; 4 Department of Systems Medicine, Tor Vergata University of Rome, 00131 Roma, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Di Sante
authors.affiliation: 1 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy ; 2 Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy ; 3 Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy ; 4 Department of Systems Medicine, Tor Vergata University of Rome, 00131 Roma, Italy.
authors.forename: Erika
authors.initials: E
authors.lastname: Limoncin
authors.affiliation: 1 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy ; 2 Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy ; 3 Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy ; 4 Department of Systems Medicine, Tor Vergata University of Rome, 00131 Roma, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Mollaioli
authors.affiliation: 1 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy ; 2 Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy ; 3 Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy ; 4 Department of Systems Medicine, Tor Vergata University of Rome, 00131 Roma, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Ciocca
authors.affiliation: 1 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy ; 2 Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy ; 3 Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy ; 4 Department of Systems Medicine, Tor Vergata University of Rome, 00131 Roma, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Carosa
authors.affiliation: 1 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy ; 2 Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy ; 3 Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy ; 4 Department of Systems Medicine, Tor Vergata University of Rome, 00131 Roma, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Sanità
authors.affiliation: 1 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy ; 2 Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy ; 3 Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy ; 4 Department of Systems Medicine, Tor Vergata University of Rome, 00131 Roma, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Di Cesare
authors.affiliation: 1 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy ; 2 Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy ; 3 Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy ; 4 Department of Systems Medicine, Tor Vergata University of Rome, 00131 Roma, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lenzi
authors.affiliation: 1 Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy ; 2 Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy ; 3 Department of Biotechnological and Applied Clinical Sciences, Division of Radiotherapy, Laboratory of Radiobiology, University of L'Aquila, L'Aquila, Italy ; 4 Department of Systems Medicine, Tor Vergata University of Rome, 00131 Roma, Italy.
authors.forename: Emmanuele A
authors.initials: EA
authors.lastname: Jannini
keywords: Hypogonadism; prostate cancer (Pca); psychotherapy; radiotherapy; testosterone; treatment
references.citation: Endocr J. 2012;59(12):1099-105
references.pmid: 22972022
references.citation: Cancer. 2002 Oct 15;95(8):1773-85
references.pmid: 12365027
references.citation: BJU Int. 2012 Dec;110(11 Pt B):E541-6
references.pmid: 22584031
references.citation: Health Psychol. 2003 Sep;22(5):443-52
references.pmid: 14570527
references.citation: J Gerontol A Biol Sci Med Sci. 2005 Nov;60(11):1451-7
references.pmid: 16339333
references.citation: J Natl Cancer Inst. 1998 May 20;90(10):766-71
references.pmid: 9605647
references.citation: BJU Int. 2011 May;107(9):1343-4
references.pmid: 21518226
references.citation: BJU Int. 2014 Aug;114(2):229-35
references.pmid: 24898919
references.citation: Psychooncology. 2003 Jul-Aug;12(5):463-73
references.pmid: 12833559
references.citation: Prostate. 2012 Oct 1;72(14):1491-505
references.pmid: 22396319
references.citation: Int J Impot Res. 2009 Jan-Feb;21(1):9-23
references.pmid: 18633357
references.citation: J Clin Endocrinol Metab. 2012 May;97(5):1508-16
references.pmid: 22419720
references.citation: N Engl J Med. 2010 Jul 8;363(2):123-35
references.pmid: 20554979
references.citation: J Clin Endocrinol Metab. 2001 Feb;86(2):724-31
references.pmid: 11158037
references.citation: Soc Sci Med. 2006 May;62(10 ):2577-90
references.pmid: 16361029
references.citation: J Clin Oncol. 2003 Nov 1;21(21):3979-86
references.pmid: 14581420
references.citation: Cancer. 2007 Feb 1;109(3):536-41
references.pmid: 17183557
references.citation: Eur Urol. 2009 Aug;56(2):237-44
references.pmid: 19375217
references.citation: Cancer. 2005 Jun 1;103(11):2412-8
references.pmid: 15858824
references.citation: J Gen Intern Med. 2001 Oct;16(10):649-55
references.pmid: 11679031
references.citation: J Urol. 2013 Aug;190(2):639-44
references.pmid: 23395803
references.citation: Cancer Res. 2004 Dec 15;64(24):8867-75
references.pmid: 15604246
references.citation: J Urol. 2003 Jun;169(6):2166-9
references.pmid: 12771740
references.citation: J Natl Cancer Inst. 2008 Feb 6;100(3):170-83
references.pmid: 18230794
references.citation: Psychooncology. 2006 Nov;15(11):937-53
references.pmid: 16521081
references.citation: J Urol. 2004 Sep;172(3):920-2
references.pmid: 15310998
references.citation: Psychooncology. 2001 Mar-Apr;10(2):147-55
references.pmid: 11268141
references.citation: Cancer. 2002 Mar 15;94(6):1854-66
references.pmid: 11920549
references.citation: Prostate. 2010 Oct 1;70(14):1600-7
references.pmid: 20607766
references.citation: Ann Intern Med. 2003 Aug 5;139(3):161-8
references.pmid: 12899583
references.citation: Cell Cycle. 2007 Mar 15;6(6):647-51
references.pmid: 17387277
references.citation: J Urol. 1998 Aug;160(2):449-53
references.pmid: 9679896
references.citation: Korean J Urol. 2012 Jan;53(1):9-13
references.pmid: 22323967
references.citation: Health Psychol. 2002 May;21(3):288-93
references.pmid: 12027035
references.citation: Ann Oncol. 2008 Feb;19(2):395-6
references.pmid: 18156142
references.citation: Eur Urol. 2006 Nov;50(5):935-9
references.pmid: 16875775
references.citation: Arch Surg. 1950 Sep;61(3):433-40
references.pmid: 15433723
references.citation: J Androl. 2009 Jan-Feb;30(1):1-9
references.pmid: 18772485
references.citation: Eur Urol. 2009 Jul;56(1):97-103
references.pmid: 19282098
references.citation: Cancer Res. 1989 Jul 1;49(13):3474-81
references.pmid: 2731169
references.citation: Curr Urol Rep. 2011 Jun;12(3):223-8
references.pmid: 21365235
references.citation: Front Neuroendocrinol. 2014 Jan;35(1):42-57
references.pmid: 24076484
references.citation: BMC Cancer. 2008 Jul 24;8:207
references.pmid: 18651985
references.citation: N Engl J Med. 2011 Jul 14;365(2):107-18
references.pmid: 21751904
references.citation: Psychooncology. 2004 Jan;13(1):47-60
references.pmid: 14745745
references.citation: Int J Endocrinol. 2012;2012:625434
references.pmid: 22505891
references.citation: Lancet Oncol. 2010 Nov;11(11):1066-73
references.pmid: 20933466
references.citation: J Sex Med. 2011 Apr;8(4):946-55
references.pmid: 21457469
references.citation: Eur Urol. 2014 Jan;65(1):99-112
references.pmid: 24050791
references.citation: J Consult Clin Psychol. 2004 Dec;72(6):1122-35
references.pmid: 15612858
references.citation: J Urol. 2005 Sep;174(3):1059-64; discussion 1064
references.pmid: 16094058
references.citation: Am J Mens Health. 2007 Dec;1(4):250-61
references.pmid: 19482806
references.citation: Cancer. 1967 Nov;20(11):1871-8
references.pmid: 4168724
references.citation: J Urol. 2011 Apr;185(4):1256-60
references.pmid: 21334649
references.citation: BJU Int. 2005 Jan;95(1):46-50
references.pmid: 15663527
references.citation: J Urol. 2005 Feb;173(2):533-6
references.pmid: 15643240
references.citation: J Sex Med. 2009 Apr;6(4):1165-70
references.pmid: 19207277
references.citation: J Clin Endocrinol Metab. 2005 Feb;90(2):893-903
references.pmid: 15585562
references.citation: Eur Urol. 2012 Nov;62(5):757-64
references.pmid: 22658758
references.citation: J Behav Med. 2003 Feb;26(1):31-52
references.pmid: 12690945
references.citation: Eur Urol. 2009 Feb;55(2):310-20
references.pmid: 18838208
references.citation: BJU Int. 2009 Jan;103(1):62-4
references.pmid: 18671790
references.citation: Endocr Relat Cancer. 2009 Jun;16(2):325-32
references.pmid: 19240183
references.citation: Cancer Pract. 2001 Sep-Oct;9(5):245-51
references.pmid: 11879321
references.citation: Prostate. 2010 Feb 1;70(2):200-5
references.pmid: 19760638
references.citation: Clin Psychol Rev. 2004 Jan;23(8):1139-62
references.pmid: 14729426
references.citation: BMC Cancer. 2008 Aug 08;8:226
references.pmid: 18687149