Hormone replacement therapy (HRT) and prostate cancer: fear and reality
Unfortunately, other problems arise with age, such as:
• Age-related androgen deficiency (age-related hypogonadism) is a common and common condition associated with sexual dysfunction, reproductive dysfunction, changes in the musculoskeletal system, metabolic disorders, central nervous system problems, and more. decrease in the level of free testosterone.
• Increased risk of prostate cancer - 60% of cases occur in men over 65 years old, which often requires the prescription of testosterone blocking drugs.
So what to do?
On the one hand, androgen deficiency requires replenishment of testosterone levels. Prostate cancer, on the other hand, is often treated with testosterone-blocking agents.
How to find a balance?
Historical perspective: In 1941, Charles Huggins showed that castration was useful in the treatment of metastatic prostate cancer. This became the basis for hormone therapy and won the Nobel Prize in 1966. But this fact has increased the fear of prescribing GAT in the minds of urologists in elderly patients.
A new study:
•Abraham Morgenthaler showed that 11 of 77 men with hypogonadism were diagnosed with prostate cancer.
•Ahmad Haider treated with 1000 mg of testosterone every 3 months for 10 years had testosterone levels ≤ 350 ng/dL studied 297 men and 376 men with hypogonadism without GAT. Over an 8-year period, prostate cancer was diagnosed in 2.3% of men on GAT compared to 6.9% of controls.
• Stacey Loeb showed in a case-control study that GAT reduced the risk of aggressive prostate cancer by 50%.
• Christopher J.D. Wallis found that men over 66 years of age had a 40% lower risk of prostate cancer with GAT
•Aksam Yassin found that men with GAT had a lower risk of prostate cancer (16.7%) compared to hypogonadal men without GAT (51.8%) and men with normal hormone levels (37.8%). Those on GAT also had less aggressive cancer.
Several studies have shown that GAT may be safe for men after prostate cancer treatment.
•A study by Kaufman et al. (2004): Seven radical prostatectomy patients treated with GAT did not experience cancer recurrence during a follow-up period of 2 to 13 years.
• Morales et al., in a study of patients after radiation therapy (EBRT), only one patient had a transient rise in PSA of less than 1.5 ng/ml.
• Pastuszak A., et al., after EBRT or brachytherapy (BT). then HRT-treated patients showed increased testosterone levels, improvement in testosterone deficiency symptoms, and no evidence of cancer recurrence during nearly 30 months of follow-up.
•Balbontin F. studied 20 prostate cancer patients after brachytherapy and long-term testosterone injections and confirmed that HRT did not accelerate cancer recurrence or progression.
Explaining the protective effect of testosterone there are several theories (anti-inflammatory, improving cell metabolism, improving blood circulation in the world, and the saturation theory. The saturation theory states that the androgen receptors (AR) of prostate cells have a saturation limit, after which an increase in the level of additional testosterone does not cause them to become more active or the growth of cancer cells. According to Morgentaler's work, AR reaches full saturation at a testosterone concentration of about 8-8.3 nmol/L (240-250 ng/dL).
Conclusion: GAT may be associated with a reduced risk of aggressive prostate cancer and improved prognosis based on outdated data In addition, current evidence suggests that HRT may be safe and effective, even in men with a history of prostate cancer, when used under close medical supervision.
