Prostate cancer in a hypogonadal male receiving androgen supplementation

Although androgen supplementation is clearly indicated in most hypogonadal males, it is also gaining popularity in the health management of the aging male without clearly low testosterone levels as the concept of male menopause becomes more accepted and recognized. The benefits include improved energy, sexual function and bone strength. A potential downside of exogenous androgen is the provocation of an underlying prostate cancer, which now represents the most common type of cancer and the second most common cause of cancer death among men in Canada. This problem is illustrated in our case of prostate cancer in a hypogonadal male on androgen supplementation. We recommend that serum PSA and digital rectal examination (DRE) be performed prior to the initiation of and regularly throughout the course of androgen supplementation. Changes in either should be investigated appropriately and termination of androgen supplementation should be considered an important component of management of prostate cancer in these patients.