The Benefits of Testosterone Treatment in Prostate Cancer

The prerequisites for active surveillance included a maximum PSA measurement of 10 ng/mL and a Gleason score of 6 or less (1). In 47.3% of patients from Baden-Württemberg, the PSA value was not known. 52% of patients changed to active treatment without a clear clinical rationale, making the rate of 2-year active surveillance low compared to international studies. In addition to including a standardized evaluation of an initial magnetic resonance imaging (MRI) scan to enroll in active surveillance in future studies, the documentation of serum testosterone concentrations, prostate volumes, ethnic background (men with dark skin have a higher risk of dying from prostate cancer), and the intake of finasteride/ dutasteride could / may be important.

Testosterone treatment is not associated with an increased risk of prostate cancer. This was recently shown in the TRAVERSE Trial, where the baseline serum testosterone concentration was 227 ng/dL and the median testosterone therapy concentration was 371 ng/dL (2). The saturation model showed maximal stimulation of prostate tissue for a serum testosterone concentration of 250 ng/ dL (8 mmol/L)—meaning that the PSA value may be measured falsely low when serum testosterone concentrations are below 250 ng/dL (3). Approximately 15% of men with testosterone deficiency and a PSA measurement below 4 ng/mL have biopsy proven prostate cancer. 5-alpha reductase inhibitors reduce serum PSA by 50% (3). In contrast to the established school of thought, patients with prostate cancer can undergo testosterone treatment with often dramatic improvement in life energy (3, 4). In patients under active surveillance, the baseline PSA value was 3.29-5.66 ng/mL, with a serum testosterone concentration of 238-328 ng/dL. After starting testosterone therapy the PSA value was 3.6-4.31 ng/mL with a serum testosterone concentration of 664 ng/dL (4).