PROSTATE SAFETY AND TESTOSTERONE TREATMENT

M.R. Feneley 1, M. Carruthers 2

1 University College London, London, UK
2 Mens Health Centre, London, UK

Introduction: For patients taking testosterone supplementation, clinical concern relates to the progress of undiagnosed prostate cancer or its development with advancing age. The historical basis for concerns of prostate cancer will be considered in relation to contemporary clinical practice and concepts of prostate cancer biology, both of which have advanced considerably within the PSA era. An updated audit of prostate safety from the UK Androgen Study (UKAS) will be presented.

Methods: 1,675 men with androgen deficiency and receiving testosterone treatment have been monitored for up to 15 years. All patients have undergone at least annual digital rectal examination (DRE) and PSA; abnormal findings or rising PSA have been further investigated by transrectal ultrasound and prostate biopsy for cancer detection. Urinary symptoms, renal function and endocrine profiles were also monitored. The data are compared for the different testosterone preparations used.

Results: 13 cases of prostate cancer were diagnosed by prescreening (0.5%), and 14 new cases occurred during approximately 2,400 man-years of treatment. Treatment duration prior to diagnosis of cancer ranged from 6 months to 15 years, and all tumours were clinically localized. Treatment had no significant effect on total PSA, free PSA or total/free PSA ratio. There was no significant change in urinary symptoms or renal function. These results were unrelated to testosterone preparation in spite of significant differences in endocrine profiles Conclusions: 0.58 new cases of early stage prostate cancer were diagnosed per 100 man-years, confirming that prostate cancer is an uncommon but important diagnosis in men receiving androgen replacement therapy. This study emphasises the importance of assessing for prostate cancer before commencing treatment, as well as the need for continued monitoring during treatment. Patients who are considering treatment must be advised of the interaction between undiagnosed prostate cancer and androgens, as well as the increasing risk of developing prostate cancer with advancing age.