The Effect of Testosterone Level on Risk of Prostate Cancer

Supportive and adjunctive care alongside conventional medical treatment.

In this article, we shall examine the effect of testosterone level on the risk of prostate cancer. This has remained a subject of great controversy because of the divergent views that have been put forward. Basically, the argument has been that using testosterone therapy in men who have been treated for prostate cancer in the past exposes them to the risk of developing the cancer afresh. The reason given has been that the therapy could reawaken dormant cancer cells in the body, triggering a recurrence. On the other end of the spectrum is the argument that testosterone therapy is not necessarily associated with cancer recurrence, and there have been studies to support this. We shall look at both sets of arguments in detail.

Testosterone Therapy

This is a common form of therapy that is widely used for a number of concerns in aging men. With aging comes a gradual decline in the amount of testosterone in the body, and this decline is associated with a number of problems. For instance, men at advanced ages often experience decreased libido. This effect may be related to a complex interplay of hormones within the body that follows a reduction in the amount of testosterone. In the same manner, testosterone therapy has been used for symptoms such as general fatigue and other forms of sexual dysfunction (apart from the low libido mentioned) in men with confirmed low testosterone.

Prostate Cancer

Prostate cancer is a common disease in men of advanced age. Although studies have shown that the disease can affect younger men, it has commonly been associated with advanced age. The complex interaction between different factors in the bodies of older men has been studied, and the results have indicated that the risk of prostate cancer rises as men age. Because testosterone also declines with age, some researchers have suggested a link between lower testosterone and prostate cancer risk. Studies are currently being conducted to determine whether any such relationship reflects testosterone levels in the prostate alone or in the body as a whole.

Testosterone and the Treatment of Prostate Cancer

For men who develop prostate cancer, a standard treatment has been to sharply reduce male hormones in the body (hormone therapy). This approach has been used in many cases in which prostate cancer has developed and spread. However, studies have indicated that in some cases, prostate cancer is able to withstand such treatment and grow again in the future. Researchers think one reason is that prostate cancer cells may be able to make their own androgens (male hormones such as testosterone) or become more sensitive to them. This means that even when the amount of testosterone in the blood is greatly reduced, levels inside the prostate tissue may stay higher, partly compensating for the loss.

Testosterone Therapy and Prostate Cancer

Standard treatments for prostate cancer include surgery, radiation therapy, hormone therapy, chemotherapy and immunotherapy. For many years, doctors were concerned that when men who have been successfully treated for prostate cancer later receive testosterone therapy, the chance of the cancer coming back could be increased. If this were so, testosterone therapy would carry added risk for these men. However, there have been arguments to the contrary. Since many studies have been conducted on this matter, we summarize the most important points here:

• Although some studies have suggested that giving testosterone therapy to men who have been successfully treated for prostate cancer exposes them to the risk of the disease returning, the increase in risk, if any, appears small in the studies done so far. Because the association has not been firmly established, whether to offer the therapy to these men depends on the judgment of their specialist. The outcome of testosterone therapy in men who have been treated for prostate cancer cannot be predicted with certainty.
• There has been evidence to suggest that men with low testosterone levels may be at higher risk of prostate cancer than men with normal levels. Testosterone therapy does not remove that risk, and it is not a treatment for prostate cancer.

If you have had prostate cancer, testosterone therapy should be considered only together with your urologist or oncologist, with careful follow-up, including PSA monitoring.

Concluding Remarks

AWAREmed Health and Wellness Resource Center offers physician-led hormone evaluation and supportive, integrative care for people affected by cancer, alongside their oncology team. Feel free to contact Dr. Dalal Akoury, MD, MPH, an experienced integrative physician, for an appointment at (423) 430-6170 or book a consultation. You may also like Managing Andropause.