Lokedogg
Vet
- Joined
- Jan 4, 2008
- Messages
- 1,113
Monday, 16 March 2009 BERKELEY, CA (UroToday.com) - Late onset hypogonadism (LOH) is the syndrome of declining androgen production with age that may result in sexual dysfunction, fatigue, depressed mood, impaired cognition and decreased muscle mass [1]. Treatment of LOH in the form of testosterone replacement therapy (TRT) is appropriate when symptoms accompany a testosterone level that is below the lower limit of normal, generally accepted to be 300 ng/dL [2]. Eugonadal androgen levels are essential to male health, and TRT leads to desired improvements in sexual function and libido, mood, as well as overall quality of life. Another recently identified advantage of TRT is its positive cardiovascular effect that may improve the symptoms of metabolic syndrome [3], including cholesterol levels, insulin sensitivity, and central obesity [4]. A primary concern in treating LOH is the potential increased risk of prostate cancer, and controversy persists as to whether testosterone can awaken a clinically insignificant prostate cancer. Short-term changes in PSA levels during TRT have been reported, and a small, but clinically insignificant increase is generally observed. Wang et al. reported that after a small increase in mean PSA level of 0.26 ng/mL at 6 months, there were no further significant increases with continued TRT over the following 3 years [5]. The effect that TRT has on PSA levels after 3 years had not been previously reported. Additionally, the mean rate of prostate cancer in published short-term TRT trials is approximately 1% [6], but the incidence of prostate cancer with long-term TRT is unknown. In our study, we aimed to review patients receiving TRT for LOH in order to evaluate the long-term changes in PSA, the cardiovascular effects of TRT, as well as to review men diagnosed with prostate cancer during TRT [7]. In all, 81 hypogonadal men were followed for a mean (range) of 34 (6?144) months after starting TRT. Testosterone levels, PSA levels, and cardiovascular parameters were assessed every 6?12 months. We found an appropriate normalization of testosterone levels on average, with over 90% of men reporting improvement in their symptoms. Four men (4.9%) developed prostate cancer at a mean 32.5 months after starting TRT, and all were found to have low grade disease that was successfully treated. The PSA levels in men who developed prostate cancer on TRT increased on average 1.8 ng/mL from baseline to 18 months, and 3.2 ng/mL from baseline to 36 months (P<0.05). In men without prostate cancer (95.1%), PSA levels did not increase significantly at 1-year intervals for 5 years. Total cholesterol improved from 204 to 167 mg/dL (P<0.05) after 36 months of TRT as well. PSA levels were shown to remain stable after normalization of testosterone for at least 5 years, prostate cancer was effectively diagnosed and treated in these men, and the incidence of prostate cancer among the men with LOH on TRT in our series was no greater than that in the general population. Thus, TRT effectively treats LOH and does not increase the overall risk of developing prostate cancer. Despite these findings, men treated with TRT should continue to be carefully monitored. References:1. Raynor MC, Carson CC, Pearson MD, Nix JW. Androgen deficiency in the aging male: a guide to diagnosis and testosterone replacement therapy. Can J Urol 2007; 14: 63?8. 2. Bhasin S, Cunningham GR, Hayes FJ et al. Testosterone therapy in adult men with androgen deficiency syndromes: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2006; 91: 1995?2010. 3. Makhsida N, Shah J, Yan G, Fisch H, Shabsigh R. Hypogonadism and metabolic syndrome: implications for testosterone therapy. J Urol 2005; 174: 827?34. 4. Shabsigh R, Katz M, Yan G, Makhsida N. Cardiovascular issues in hypogonadism and testosterone therapy. Am J Cardiol 2005; 96: 67M?72M. 5. Wang C, Cunningham G, Dobs A et al. Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men. J Clin Endocrinol Metab 2004; 89: 2085?98. 6. Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med 2004; 350: 482?92. 7. Coward RM, Simhan J, Carson III CC. Prostate-specific antigen changes and prostate cancer in hypogonadal men treated with testosterone replacement therapy. BJU Int. 2008 Dec 23. [Epub ahead of print]. Written by: Robert M. Coward, MD and Culley C. Carson III, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract. Prostate-Specific Antigen Changes and Prostate Cancer in Hypogonadal Men Treated with Testosterone Replacement Therapy - Abstract
