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Prostate cancer in patients with Hansen's disease
Isao Kiriyama1, Kenji Ohgaki, Shuji Ohba
1Department of Urology, Nippon Medical School, Tokyo, Japan. kiriyama@nms.ac.jp
Insights
This study found prostate cancer in three leprosy patients, challenging the belief that testicular failure prevents its occurrence. Monitoring hormone levels and prostate-specific antigen is recommended for aged male leprosy patients.
Area of Science:
- Urology
- Infectious Diseases
- Endocrinology
Background:
- Hansen's disease (leprosy) is known to cause secondary testicular failure.
- This has led to the assumption that prostate cancer is unlikely to co-occur with leprosy.
- However, recent findings suggest a potential association.
Observation:
- A study observed three cases of prostate cancer among 14 patients with chronic leprosy.
- The patients diagnosed with prostate cancer were aged 72, 80, and 82 years old.
- Two of the three prostate cancer patients exhibited elevated follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels.
Findings:
- The presence of prostate cancer in leprosy patients challenges prior assumptions.
- Elevated FSH and LH levels in two patients suggest their prostate cancers may respond to hormone therapy.
- The study highlights the potential influence of hormonal imbalances due to leprosy on prostate cancer development and treatment.
Implications:
- Aged male patients with Hansen's disease require comprehensive screening for prostate cancer.
- Recommended screening includes measuring FSH, LH, testosterone, and prostate-specific antigen (PSA).
- Consider prostate biopsy for elevated PSA levels, even in the presence of hypogonadism.
Abstract:
Hansen's disease causes testicular failure secondarily, and because of this, it has been considered that prostate cancer would not be found in association. Three of 14 patients with chronic leprosy in Suruga National Sanatorium Hansen's Disease Hospital were found to have prostate cancer. A 72-year-old with lepromatous leprosy was diagnosed with stage T3a prostate cancer and treated with radical prostatectomy after hormonal therapy, plus irradiation. An 80-year-old with lepromatous leprosy was diagnosed with stage T2 prostate cancer and treated with irradiation and follow up only without hormone therapy and surgery because of his low testosterone level and old age. An 82-year-old with borderline leprosy was diagnosed with stage T1c prostate cancer and because of the pathological finding of low Gleason score and his old age, he was treated with hormonal therapy only. Two of the three cases had elevated concentrations of follicle-stimulating hormone and luteinizing hormone, which suggests that their prostatic cancers might have been equivalent to be under the influence of hormone therapy. Therefore, in aged male patients with Hansen's disease, the follicle-stimulating hormone, luteinizing hormone and testosterone concentrations should be measured, as well as that of prostate-specific antigen, and a prostate biopsy should be also considered if the prostate-specific antigen concentration is increased, even with hypogonadism.