[Testosterone and the prostate]

The normal development and function of the prostate, as well as its pathological growth, are governed by a lifelong dependency on endogenous androgens, the majority of which are of testicular origin. In contrast to other androgen-sensitive tissues, androgenic effects in the prostate are only exerted by the intracellular metabolite dihydrotestosterone. Conflicting evidence exists regarding changes of the intracellular prostatic androgen receptors in benign prostatic hyperplasia and prostatic carcinoma. Equally conflicting is the clinical evidence concerning androgen metabolism in patients with manifest or metastatic prostate cancer. So far, there is no clear evidence for an increased risk of prostatic neoplasia with testosterone substitution in absolute or partial androgen deficiency. However, in view of the high prevalence of latent prostate cancer, caution is advisable.