Wednesday, April 22, 2015

Is Testosterone Replacement Therapy "Feeding the Fire" of Prostate Cancer?


Testosterone replacement therapy (TRT) is the administration of testosterone to men with abnormally low testosterone, termed hypogonadism, or "low T," Men with symptoms of low testosterone, can often benefit from TRT. Common symptoms of hypogonadism in post-pubertal men commonly include decreased muscle mass, decreased energy, depressed mood, decreased libido, decreased spontaneous erections, and erectile dysfunction [Wang et al., 2008, Basaria, 2014].

While TRT has been used for decades the last decade has seen a dramatic increase in the use of TRT. The percentage of men in the Unites States over 40 years of age prescribed TRT increased from less than 1% in 2001 to nearly 3% in 2011 [Baillargeon et al., 2013]. The increase in TRT and lack of data from large, long term randomized controlled trials (RCT) has raised concern for unrecognized adverse health risks, including potential increases in cardiovascular disease and prostate cancer (PC).

Changes in androgen use over time. From Baillargeon et al., 2013.

There is large body of both historic and modern data supporting a role for androgens in PC pathogenesis and progression.

In 1941, Huggins and Hodges proposed that PC growth was driven by androgens, after observing benefits of castration in PC patients [Huggins et al., 1941]. Current laboratory data demonstrate that many PC cell lines depend on testosterone for growth and spread.  [Kyprianou et al., 1990, Webber et al., 1996, Schwab et al., 2000]. In animal models, testosterone promotes PC tumor growth [Bladou et al., 1996, Ahmad et al., 2008].

The data supporting the androgen hypothesis has led to the dogma that TRT in PC patients is like "feeding the fire." Historically, there is data supporting this concept. In 1982 Fowler et al. reported on 52 men with metastatic PC patients who recieved testosterone. 38% of men had elevations in prostatic acid phosphatase (a blood test used to monitor PC), 2 men had measurable metastatic progression, and ther were 4 deaths [Fowler et al., 1982]. Importantly, these patients had advanced disease, and many had prior androgen deprivation [Fowler et al., 1982]. Thus, it would not be appropriate to apply these observations to men with clinically localized disease who receive early primary treatment and PSA monitoring.

 

There is currently no reliable data indicating an increase in PC in men without PC undergoing TRT.

The majority of studies on TRT and PC are small, and to date, there have been no prospective studies on TRT with sufficient patient numbers to determine increased PC risk. By one estimate, 6,000 patients receiving 5 years of TRT would be needed to detect a 30% increase in PC incidence [Bhasin et al., 2003]. In a systematic review of 40 prospective studies, there was no study which demonstrated an association between TRT and PC risk in men without prior PC. In addition, a meta-analysis of 19 studies, there was no significant increase in PC or significant PSA increases necessitating prostate biopsy. [Calof et al., 2005].

 

TRT in patients with localized PC appears safe, based on limited data

Using Medicare data, Kaplan and colleagues reported on 149,354 men, including 1,181 men who received TRT after a diagnosis with PC. Overall, TRT was not associated with PC deaths [Kaplan et al., 2014]. Similarly, Pastuszak and colleagues reported on 103 men who after prostatectomy were treated with TRT. There was an overall increase serum PSA, but no evidence of increased cancer recurrence over 36 months [Pastuszak et al., 2013]. In a smaller study, Morgentaler et al. examined 13 patients with untreated PC, enrolled in an active surveillence program and receiving TRT. After a median follow-up of 2.5 years, 2 men had worse pathology on subsequent biopsy, but no cases of disease or PSA progression were seen [Morgentaler et al., 2011].

 

Summary

Overall, there remains no clear answer to the question "Does testosterone promote prostate cancer development in humans?" Thus, TRT in men with prostate cancer remains controversial. There is clear evidence that androgens can promote PC in animal models. It is clear that the influence of testosterone on PC disease progression is of paramount importance to both patients and providers as they weight the potential benefits of TRT. Currently, there is a growing amount of evidence that TRT is safe in well-selected men with clinically localized PC. However, these results are based on TRT in a small number of patients. Furthermore, the heterogeneity in PC progression and aggressiveness may give rise to heterogeneity in the responsiveness of tumors to TRT. Thus, until the results of future RCTs are available, TRT should only be offered to select patients who are carefully monitored and well-informed about the potential risks and benefits.

 

This blog was written by Jason E. Michaud M.D., Ph.D., urology resident at the Brady Urological Institute, currently in his laboratory research year.

 


 





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    Syndrome Fibrodysplasia ,Epilepsy Dupuytren's disease, Diabetes ,Coeliac disease, Angiopathy, Ataxia,Arthritis,Amyotrophic Lateral Sclerosis,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Hiv_ Aids,Herpes,Inflammatory bowel disease ,Copd,Diabetes.
    Here Is His Contact Info......[Email...drituaherbalcenter@gmail.com/Whatsapp...+2348149277967]

    ReplyDelete
  18. If you have Herpes in your whole body such as fever blisters, hsv, or roofing shingles you know what it is like to stay with the pain and discomfort that herpes delivers. I don't need to tell you how awesome it would be to find something that works so well that you no longer need to fear about stress or outbreak,Dr Itua herbal medicine cure my herpes in two weeks of taking it.is genuine and natural herbal medicine it has no side effect, The reason I'm writing this is that I promised Dr Itua I will share his herbal work to the world to see Herpes is no more a big deal.also Dr Itua can as well cure the following diseases...HIV,Hsv 1/2,Hepatitis B,Cancer, Diabetes, Men/Woman Infertility, Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity
    Syndrome Fibrodysplasia Ossificans Progressiva.Fatal Familial Insomnia Facator V Leiden Mutation , Lottery Spell,Copd, Shingles,Fibroid, Fibromyalgia, Liver/Kidney Inflamotry, Epilepsy, Coeliac disease,Creutzfeldt–Jakob disease,Cerebral Amyloid Angiopathy, Ataxia,Arthritis,Amyotrophic Lateral Sclerosis,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic Asthma. Here His Contact...drituaherbalcenter@gmail.com/Whatsapp Phone.+2348149277976. I paid for his herbal medicine and sent it to me through Courier Service which I pick it urgently and used.

    ReplyDelete
  19. HOW DR PERFECT ENLARGEMENT CREAM HELP ME TO ENLARGE MY PENIS YOU CAN ADD HIM UP ON WHATSAPP +1(256) 251 3614

    My name is David Richardson from USA I want to share a testimony of how Dr Perfect herbal mixture cream saved me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing and I was also having weak erection problem. I can't make love to my wife and my penis was just too small, a full grown man like me having 3 inches penis and to worsen it I don't last long in sex I can't even last four minutes it was really a big shame to me. My wife was really tired of me because my sex life was very poor, she never enjoyed sex, I was always thinking and searching for solutions everywhere until when I saw a testimony of how Dr Perfect herbal mixture cream have been helping people regarding their sex life, so I decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 10 inches I couldn't believe my eyes and as I speak now my penis is now 10 inches long and I don't have weak erection anymore. I can make love to my wife longer in bed. And my marriage is now stable my wife is now enjoy me very well in bed. All thanks to Dr Perfect for enlarging my penis he indeed save my marriage. You can contact him at solutiontoallproblems1@gmail.com or you can add him up on WhatsApp +1(256) 251 3614. you can also view my blog http://davidrichardson12356.over-blog.com. He also specializes in the following things
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    Cancer
    Hsv
    Chronic venous disease
    and others

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  22. Unfortunately there are a lot of AIDS/Herpes denials on Herbal cures still out there. I did research on them after I was tested HIV/Herpes positive I was so worried am I going to die soon. I continue my search again on herbal remedy for Std, then I found lots of testimony on how Dr Itua Herbal Medicine Cured HIV/Aids, Herpes Virus,Copd, Hepatitis, Diabetes, On websites sharing their testimonies, which made much more sense to me. All the authors pronounce Dr Itua As a man with Good Heart, I pick interest in their testimonies and I contact him about my situation then he gave me procedure how it works, I proceed after one week he courier his Herbal Medicine to me and instruct me on how to drink it for two weeks to cure. I receive His Herbal Medicine so I drank it for two weeks as I was told then after 2 days I go for a test I found out I was cured from HIV/Aids & Herpes Virus, I pay homage to him 2 months ago to his country to celebrate with him on his African festival which he told me it usually happens every year. I know there are lots of (HIV)/Aids&Herpes Virus denials of Herbal Remedy movement the same few doctors and they represent a very small faction of the community. I could have died because I refused Natural Herbs Cures for so long, but luckily, by the grace of God I am alive to tell my story. Contact Info...Whatsapp Number...+2348149277967,Email...drituaherbalcenter@gmail.com/My Instagram Username...avat5634 Just in case you need someone to talk with. He cure tthe following diseases below...1. Herpes 2. cancer 3. HIV / AIDS 4. hepatitis 5. Bring my ex back 6. Leprosy 7. SARS 8. Bubonic plague
    9. Cerebrovascular disease 10. Lower respiratory infections 11. Syphilis 12. Influenza A-H1N1 (swine flu) 13.Ischemic heart disease 14. Chronic obstructive pulmonary disease 15. Whooping cough 16. Perinatal complications 17. diarrhea 18 .. lung cancer.

    ReplyDelete
  23. I am 29 years old and I was diagnosis of Breast cancer, easy well and have a similar story except my first acceptance as a Herbal medicine denials. I wasn’t into the movement Perseid and didn’t establish connections with any of them really, just had faith in believing how they work. I say this because it was during using Dr Itua herbal medicine i now then testify herbal medicine is real, Dr Itua herbal medicine cure my breast cancer I was suffering from for 2 years. Dr Itua herbal medicine is made of natural herbs which has no side effect and is easy to drink as well. Contact Dr Itua herbal Center if you are suffering from the same Breast Cancer or any kind of human Diseases including....HIV/AIDS, HERPES COLORECTAL CANCER, BLADDER CANCER, PROSTATE CANCER, KIDNEY CANCER, LUNG CANCER, SKIN CANCER, UTERINE CANCER, LEUKEMIA, VIRUS, HEPATITIS, WOMEN/MEN INFERTILITY, LOVE SPELL,LOTTERY SPELL. HIS CONTACT EMAIL/WHATSAPP: drituaherbalcenter@gmail.com/+2348149277967

    ReplyDelete
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  26. HOW DR PERFECT ENLARGEMENT CREAM HELP ME TO ENLARGE MY PENIS YOU CAN ADD HIM UP ON WHATSAPP +1(256) 251 3614

    My name is David Richardson from USA I want to share a testimony of how Dr Perfect herbal mixture cream saved me from shame and disgrace, my penis was a big problem to me as the size was really so embarrassing and I was also having weak erection problem. I can't make love to my wife and my penis was just too small, a full grown man like me having 3 inches penis and to worsen it I don't last long in sex I can't even last four minutes it was really a big shame to me. My wife was really tired of me because my sex life was very poor, she never enjoyed sex, I was always thinking and searching for solutions everywhere until when I saw a testimony of how Dr Perfect herbal mixture cream have been helping people regarding their sex life, so I decided to give him a try and to my greatest surprise in less than one week of taking the herbs my penis grow to 10 inches I couldn't believe my eyes and as I speak now my penis is now 10 inches long and I don't have weak erection anymore. I can make love to my wife longer in bed. And my marriage is now stable my wife is now enjoy me very well in bed. All thanks to Dr Perfect for enlarging my penis he indeed save my marriage. You can contact him at solutiontoallproblems1@gmail.com or you can add him up on WhatsApp +1(256) 251 3614. you can also view my blog http://davidrichardson12356.over-blog.com. He also specializes in the following things
    Herpes virus
    Cancer
    Hsv
    Chronic venous disease
    and others

    ReplyDelete
  27. Thanks for sharing, nice article!. Thank you
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    ReplyDelete
  28. My name is donald boykins , am here to appreciate Dr Akhigbe for using his herbal medicine to cure my Herpes virus. Is about 3 years and  6 months now I have been living with this virus and it has been a serious problem to me, I was so confused cause i have been taking several drugs to be cured but all of my effort was in vain,one morning I was browsing through the internet then I saw several testimonies about Dr. Akhigbe curing people from Herpes virus and immediately i contacted Dr. Akhigbe on his email: drrealakhigbe@gmail.com, i told him about my troubles and he told me that i must be cured, he gave me some instructions and which i rightly followed. so he prepared a herbal medicine  and sent it to me which i used for 2 weeks and i was cured everything was like a dream to me and my Herpes virus was totally gone, dr .Akhigbe, God bless you and give you more power and ability for more cure.I don't know if there is any one out there suffering for herpes virus or any of these diseases..DIABETES, CANCER, HIV/AIDS, HERPES  HEPATITiS A AND B , HEART DISEASE, CHRONIC DISEASE,EPILEPSY, LUPUS, STROKE,PARKINSON'S DISEASE, SPINAL CORD INJURY, ECZEMA, KIDNEY DISEASE, ACME, BACK PAIN,EXTERNAL INFECTION, CORONARY ARTERY DISEASE, COMMON COLD, POLIO etc.   why don't you contact dr.Akhigbe today and be free from your diseases because he is very good and honest Doctor and he is also called the godfather of herbal root contact him via email; drrealakhigbe@gmail.com or whatsApp him on +2348142454860  website  https:drrealakhigbe.weebly.com

    ReplyDelete
  29. Get rid of Cold Sores, unexpected Outbreak and Herpes Virus? then you don't have to keep waiting for treatment when the is a herbal medicine that cure this virus. I was searching online for Herbal Cure for Herpes Virus when I saw a testimony online about Dr. Akintunde and how he cured a lady of HSV1 with his.
    natural herbal medicine and tested Negative and in less than a month she was cured of this virus. So it took me time to believe that this was true, because my family Doctor tried all his best to get rid of this virus in my body system but yet no cure and I suffered from outbreak and Cold Sores always. I had to contact Dr. Akintunde after I have access his website and i had faith in God that I was going to be fine and free of this virus one day. Finally I contacted Dr. Akintunde on his WhatsApp number that I saw on the testimony post online, and after our conversation the Doctor only promise me that I was going to be cured and free of this virus after taking his natural herbal medicine because I was tired of my situation with this virus it was so distracting to my life and whole family. Later Dr. Akintunde send some Herbal medicine to me through UPS courier service, with instructions on how to used this medicine, to my biggest surprise first week of taking my herbal medication I saw great improvement and I still think that it's a dream but this is real, I now test Negative of this virus today and my blood pressure well regulated now, my family doctor after my test was extremely surprise to see my test result change to HSV1 Negative and no more symptoms, cold sores, sores throat and outbreak again. I wish to tell everyone about this, mostly if you have this virus then do yourself good to contact Dr. Akintunde and see what the Lord can do through this Herbal Doctor's medicine in less than a month. 100% free from herpes Virus. I and my family say "thank you" Sir, for helping my life. You are a blessing to this generation and God will reward you richly

    Email: drakintundehomecare@gmail.com

    WhatsApp number: +234 703 524 5593

    ReplyDelete
  30. I glorify the lord Almighty on your behalf sir Dr Chukwu Madu herbal home, let the grace continue with you. Am so happy right now am cured totally from Cancer with the help of your herb DR Chukwu Madu herbal home.
    You have been curing people with your powerful herbs thank you so much for your truth and straight forwardness towards your patients ,I read about your great herbal home on the Internet and how you cure people of their different virus and I contacted you without time wasting when you told me I will be totally cured soon and I hoped on you ,and you never let me down. My name DESMOND WALTER from Texas. Am greatfull Doc. Viewers join me say thank you to this great herbalist from Nigeria part of African who cures people of their Virus with his great herbs, even if you have some days to live contact him and be saved forever iam very sure of Dr Chukwu Madu herbal home.[ dr.chukwumaduherbalhome@gmail.com] or talk with him directly on WhatsApp via [+2347030936239] am all good DOC.

    ReplyDelete
  31. Suffering from herpes virus is a terrible experience because i was told it has no cure,the good news am happily sharing now is the great power behind herbal medication i got diagnosed of herpes virus in the year  2016 and in 2018 i started having outbreaks and it became more terrible for me to bare,One blissful morning i came across a blog comment posted by a man call Thompson on how he was cured of herpes simplex virus type 2 with the herbal medication of Dr CHUKWU MADU Herbal Home) who is a specialist in curing all kinds of std virus and chronic disease with herbs,i immediately copied out his contact mail that was dr.chukwumaduherbalhome@gmail.com Or Via WhatsApp  +2347030936239 and i explain all my problems to him, he was very honest with me and also kept his promise to get me cured with his herbs if i follow the prescriptions he gives along with the medication which i did exactly as he prescribed, to God be the glory My herpes simplex virus i have been suffering from got cured in just 2 weeks after completing the dose of his herbal cure. once again thank you so much sir for restoring my health back and most especially my skin. Please for any who has health problem of any kind should mail him on the email provided above. Give him a chance and see what he can do. JANE lisaru from MALAYSIA.
    .

    ReplyDelete