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Reply: Influence of demographic factors and biochemical characteristics on the prostate-specific antigen (PSA) response to testosterone replacement therapy

International Journal of Impotence Research volume 18, pages 574–575 (2006)Cite this article

It is well known that testosterone replacement therapy (TRT) in hypogonadal men has beneficial effects on varies body functions including the sexuality.1 However, prostate cancer is one of the hormone-dependent cancers at least during the initial of the clinical progress.2 Owing to the fact that an occult prostate cancer can be induced by TRT,3 monitoring the alterations in serum prostate-specific antigen (PSA) levels are clinically important. In their article, Rhoden and Morgentaler analyzed this important topic in two age groups below and over 60 years (38 and 20 subjects, respectively). The evaluation was implemented after one year of treatment using two delivery systems (parenteral and transdermal) with pretreatment prostate biopsy control.

I think, at the end of 1 year of TRT, a single serum PSA assay was insufficient to evaluate the PSA response. The investigation of PSA velocity on more than one PSA assay during a longer duration of TRT would be more valuable for the aim of this study. In addition, despite the significant increase in the post-treatment testosterone levels that should have resulted in positive PSA response, it was interesting that there were a group of patients (21%) who showed a negative PSA response even below −0.51 ng/ml and the possible reasons of this drop might be better to be discussed. In a similar study on the same topic, Gerstenbluth determined mean pre- and post-treatment PSA levels were 1.86 and 2.82 ng/ml (ranges 0.0–15.8 and 0.0–32.4, P<0.01, mean PSA change was 0.96 ng/ml – quite high compared to the result of the present study) respectively, in 54 patients with 30.2 months mean follow-up and did not mention any negative PSA response.4 On the other hand, although the 75% of newly diagnosed prostate cancer patients over 65 years old3 and age over this being one of the risk factors for occult prostate cancer,5 the age of the study group analysed by Rhoden and Morgentaler (mean 58.3±8.7, range 42–77) seemed to be younger.

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References

  1. Rhoden EL, Morgentaler A . Influence of demographic factors and biochemical characteristics on the prostate-specific antigen (PSA) response to testosterone replacement therapy. Int J Impot Res 2006; 18: 201–205.

    Article  CAS  Google Scholar 

  2. Schröder FH . Hormonal therapy of prostate cancer. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ (eds). Campbell's Urology, 8th edn, vol 4, Saunders: Philadelphia, 2002, pp 3182–3208.

    Google Scholar 

  3. Reiter RE, deKernion JB . Epidemiology, etiology, and prevention of prostate cancer. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ (eds). Campbell's Urology, 8th edn, vol 4, Saunders: Philadelphia, 2002, pp 3003–3024.

    Google Scholar 

  4. Gerstenbluth RE, Manian PN, Corty EW, Seftel AD . Prostate-specific antigen changes in hypogonodal men treated with testosterone replacement. J Androl 2002; 23: 922–926.

    PubMed  Google Scholar 

  5. Kefer JC, Voelzke BB, Flanigan RC, Wojcik EM, Waters WB, Campbell SC . Risk assessment for occult malignancy in the prostate before radical cystectomy. Urology 2005; 88: 1251–1255.

    Article  Google Scholar 

  6. Benecchi L . PSA velocity and PSA slope. Prostate Cancer Prostatic Dis 2006, March 28 [E-pub ahead of print].

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  1. Department of Urology, Harran University Medical School, Arastirma ve uygulama hastanesi, Sanliurfa, Turkey

    A Verit

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The purpose of our paper was to investigate the various factors that may influence PSA changes in men receiving TRT over the course of 1 year. One of the main findings in our study was that >75% of men receiving TRT had no appreciable increase in PSA at all (0.5 ng/ml or less), and one-fifth of them actually registered a decline in PSA, as noted by the correspondent.1 As pointed out in our discussion, a wide range of PSA changes with TRT have been reported, with the large changes reported by Gerstenbluth et al.2 being at the upper end of this range.

It is possible that differences in results between studies reflect differences in study populations. Age alone does not appear to be an adequate explanation for these differences, based on analysis of the effects of age in our study. However, it is important to note that ours was the first study of this type in which all men had previously undergone prostate biopsy to rule out the presence of occult cancer. Although a small number of men subsequently proved to have cancer (with repeat biopsy prompted by substantial rise in PSA), it is reasonable to assume that the observed mean PSA changes represent the effect of TRT on benign prostate tissue. Regarding the frequency of PSA testing in men receiving TRT, based on a review of the literature we have previously recommended monitoring PSA at 3 and 6 months after starting TRT, and then once per year thereafter if no significant alterations have been observed.4

With regard to the duration of the study, previous investigations have shown that most of the PSA changes noted with TRT occur within the first 6 months of treatment, with relatively little mean change thereafter.3 This makes sense, since once serum testosterone has been normalized in treated hypogonadal men, PSA in these men should behave in similar fashion to eugonadal men.

There remains considerable confusion regarding the potential for TRT to cause progression of occult prostate cancer. As reviewed elsewhere,3, 4, 5, 6 there remains no compelling evidence in the literature that TRT in hypogonadal men causes prostate cancer growth. In particular, there is no evidence to support the argument that men over 65 years should be denied TRT because they are at increased risk of developing prostate cancer. Indeed, the natural history of prostate cancer is that it becomes highly prevalent when men are older and serum testosterone has declined, and almost never occurs during the peak testosterone years of youth.

We regret any errors regarding reference citations.

A Morgentaler1 and EL Rhoden21Harvard Medical School, Boston, USA and 2FederalSchool of Medical Sciences, Porto Alegre, Brazil

References

1. Rhoden EL, Morgentaler A. Influence of demographic factors and biochemical characteristics on the prostate-specific antigen (PSA) response to testosterone replacement therapy. Int J Impot Res 2006; 18: 201–205.

2. Gerstenbluth RE, Manian PN, Corty EW, Seftel AD. Prostate-specific antigen changes in hypogonodal men treated with testosterone replacement. J Androl 2002; 23: 922–926.

3. Bhasin S, Singh AB, Mac RP, Carter B, Lee MI, Cunningham GR. Managing the risks of prostate disease during testosterone replacement therapy in older men: recommendations for a standardized monitoring plan. J Androl 2003; 24: 299.

4. Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med 2004; 350: 482–492.

5. Morgentaler A. Testosterone replacement therapy and prostate risks: where's the beef? Can J Urol 2006; 13: S40–S43.

6. Barqawi AB, Crawford ED. Testosterone replacement therapy and the risk of prostate cancer: a perspective view. Int J Impot Res 2005; 17: 462–463.

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Verit, A. Reply: Influence of demographic factors and biochemical characteristics on the prostate-specific antigen (PSA) response to testosterone replacement therapy. Int J Impot Res 18, 574–575 (2006). https://doi.org/10.1038/sj.ijir.3901520

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