Testosterone and prostate cancer: revisiting old paradigms

Area of Science:

• Endocrinology
• Urology
• Oncology

Background:

• Androgens are crucial for prostate health, but the belief that they stimulate pathological prostate growth lacks scientific evidence.
• Current guidelines for testosterone therapy (TT) may be overly restrictive due to this misconception.

Purpose of the Study:

• To review existing literature on the relationship between testosterone and prostate cancer (PCa).
• To summarize the impact of TT on PCa development and its natural history in treated patients.

Main Methods:

• A Medline search was performed to identify relevant original articles, reviews, and editorials.
• The search focused on testosterone's role in PCa risk, development, and the effects of TT post-treatment.

Main Results:

• Serum androgen levels within a broad range are not linked to PCa risk.
• Low testosterone levels, not high, are associated with advanced PCa at diagnosis.
• TT does not increase PCa diagnosis risk or alter the natural history of PCa in men cured by treatment.

Conclusions:

• Available literature suggests TT is unlikely to increase PCa risk or cause recurrence in treated men.
• Further large prospective studies are required to confirm these findings and assess long-term effects.
• Current guidelines on TT for hypogonadal men treated for PCa may need reevaluation.