Older men who receive testosterone replacement therapy because of low testosterone are no more likely to get prostate cancer than similarly aged men not receiving testosterone, a new study found. The results will be presented at The Endocrine Society’s 90th Annual Meeting in San Francisco.

Prostate cancer is a concern regarding testosterone therapy in older men, said lead author Aksam Yassin, MD, PhD, of the Clinic for Urology and Andrology of the Segeberger Clinics in Norderstedt, Germany. “Testosterone treatment stimulates the growth of an existing prostate cancer, but there is no evidence that it causes this type of cancer,” he said.

The risk of prostate cancer and testosterone deficiency increases with age. Therefore, it is possible that a prostate cancer may occur in an older man during testosterone replacement therapy, which is unrelated to treatment, Yassin said. His research, performed with scientists from Germany and the United Arab Emirates, aimed to determine if prostate cancer occurs more often with testosterone replacement therapy in men over 50.

The study involved 154 testosterone-deficient men with an average age of 56, who had 1 to 3 years of follow-up testing. Patients received testosterone injections in a hospital clinic in Bremerhaven, Germany. Testosterone was a slow-release form called testosterone undecanoate (brand name Nebido) that is not yet available in the United States. The researchers compared these patients with 160 men visiting the clinic for a health checkup who had normal testosterone levels and did not receive testosterone treatment. Their average age was 58.

At the beginning of the study and then every 3 months afterward, all subjects had an evaluation that included a digital rectal exam, ultrasound measurement of prostate volume and a blood test for prostate-specific antigen (PSA). Increased PSA levels may indicate prostate cancer, an enlarged prostate or inflammation of the prostate (prostatitis). If a man’s PSA level was high—over 4 (micrograms per liter)—or otherwise abnormal, he underwent a prostate biopsy.

The rectal exam found no abnormalities. Eleven men receiving testosterone had a biopsy, two of which showed a small cancerous tumor on one side of the prostate. A third man was found to have a high-grade (more aggressively malignant) prostate cancer that had not yet spread to other organs. Of the 12 men in the untreated group, five had prostate cancer. Four of these tumors were on both sides of the prostate and were high grade. Therefore, there were no more prostate cancers in the group that received testosterone treatment, Yassin concluded. Moreover, the men receiving testosterone had smaller, less aggressive tumors than did the other men, he said.

“There is increasing evidence that testosterone replacement therapy in testosterone-deficient men can improve their prostate cancer symptoms, such as decreased bone and muscle mass and low sex drive and depression,” he said. “In view of the many benefits of treatment and the results of our prostate cancer study, we believe it is acceptably safe to treat older men with testosterone if there is a good reason for treatment.”

Yassin is on the speakers’ bureau for Bayer Schering, which makes the brand of testosterone undecenoate used in this study. However, patients received testosterone as a free benefit of the German social health care system, he said.

About  Prostate Cancer

Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. It occurs when cells of the prostate mutate and begin to multiply out of control. These cells may spread (metastasize) from the prostate to other parts of the body, especially the bones and lymph nodes. Prostate cancer may cause pain, difficulty in urinating, erectile dysfunction and other symptoms.

Many factors, including genetics and diet, have been implicated in the development of prostate cancer. Prostate cancer develops most frequently in men over fifty. This cancer can occur only in men, as the prostate is exclusively of the male reproductive tract. It is the most common type of cancer in men in the United States, where it is responsible for more male deaths than any other cancer, except lung cancer.

Many men who develop prostate cancer never have symptoms, undergo no therapy, and eventually die of other causes. While early prostate cancer usually causes no symptoms, symptoms may include:

• difficulty starting and maintaining a steady stream of urine,
• frequent urination,
• increased urination at night,
• blood in the urine and
• painful urination.

Advanced prostate cancer can spread to other parts of the body and this may cause additional symptoms. The most common symptom being bone pain, often in vertebrae (bones of the spine), pelvis or ribs. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and urinary and fecal incontinence.