Traditionally, we have thought and taught that management replacement therapy (TRT) causes prostate cancer to worsen. Historically, replacement therapy has been contraindicated in patients diagnosed with prostate cancer as well as in all those who are at high risk of developing it. However, There are numerous studies in the most recent medical literature that cast doubt on these outdated claims..
Replacement therapy and its relationship with prostate cancer
A recent study (the largest of its kind conducted to date) indicates that Replacement therapy may reduce risk of prostate cancer recurrenceThe study, presented at this year's AEU conference in Barcelona (March 15-20), calls into question the applicability of the hormonal prostate treatment previously proposed by Nobel Prize winner Charles Brenton Huggins.
For a long time, the medical community has considered the testosterone replacement therapy (TRT) as a type of treatment that could cause or promote prostate cancer. In fact, the Nobel Prize-winning work in Medicine in 1966 (Huggins and Hodges), reported on the dramatic impact of reducing testosterone levels on prostate cancer. Since then, drugs that help reduce hormone levels have become a standard option for many doctors and their patients to this day.
The anti-testosterone treatment left something to be desired
In the late 90s, medical professionals began to notice a curious fact: prostate cancer patients who were being treated with testosterone reduction were not dying from the cancer. Yet they were still dying. Doctors began to warn that these patients were experiencing premature deaths caused by cardiovascular disease..
This happened because Although anti-testosterone therapies treated prostate cancer, the extremely low levels of the hormone that the treatment left behind resulted in metabolic complications.:
- increased blood sugar
- increased visceral fat
- diabetes
- cholesterol
- etc.
Of course, with such deficient testosterone levels, patients on anti-androgen treatment They also began to experience a gradual loss of sexual function.
It was then that Some doctors began to suggest hormone replacement therapy to some low-risk prostate cancer patients.
Study shows low testosterone therapy reduces risk of prostate cancer recurrence
In 2008, a team of doctors from the University of California, led by Professor Thomas Ahlering, began carefully selecting the patients who would participate in the study and receive hormone replacement therapy. These were patients who had suffered from prostate cancer and had undergone radical prostatectomy: 834 men in total.
Of the total, the researchers treated about 200 men with TRT and, after a while, examined all the patients to determine the biochemical recurrence of the cancer.
The results of the study
As a result, The medical team found that cancer had recurred in only about 5% of patients treated with low testosterone therapy.. Conversely, Cancer recurred in 15% of patients who had not received replacement treatmentOverall, after accounting for differences between groups, they found a nearly threefold reduction in three years.
«Not only did replacement therapy not increase recurrence, it actually decreased its rates. While the hormone does not cure cancer, per se, yes, it can help reduce cancer growth (…). We already know that this hormone can help with physiological markers such as muscle mass, better cholesterol and triglyceride levels and an increase in sexual activity.
(...)
There have been smaller studies that have suggested that replacement therapy may not be dangerous for certain groups of patients, but this is the largest study ever undertaken. We are not suggesting that treatment methods be changed yet, but this puts us at a stage where We need to question the taboo against the use of hormone replacement therapy in the therapy of prostate cancer, especially in low-risk patients after radical prostatectomy. We need the oncology and urology community to begin reviewing the use of replacement therapy.. "
Thomas Ahlering
In light of these words from the leader of the research team, it's worth knowing what Francesco Montorsi, Deputy Secretary of the European Association of Urology, thinks about this study:
«The document is really important, since highlights the importance of monitoring testosterone levels as part of the management of patients with sexual disorders after radical prostatectomy. Obviously, selecting the right patients is vital, but if confirmed, this can have immediate benefits on quality of life; the possibility of reducing mortality would be an unexpected advantage. We now need larger studies to support this work.»
Francesco Montorsi
Conclusions on the study
To this day, there are In the US alone, nearly 4 million men suffer from hypogonadism. and it is estimated that 2-3 million in Europe. If we consider that the prevalence of this disease increases with age, It would not be surprising if this figure increased exponentially over time..
Fortunately, today Hormone replacement therapy is a real solution for these patients and, fortunately, every day it gains more visibility and support from the scientific community.
Still, there is still a long way to go since we also Increasingly, there are cases of patients who have survived prostate cancer and who show hypogonadism and who demand access to this therapy.At the moment, these patients cannot be treated, but we trust that research will advance in this direction in the coming years.
Sources:
https://www.news-medical.net, https://uroweb.org/,
https://www.researchgate.net/.
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