The effect of testosterone replacement therapy on prostate cancer: a systematic review and meta-analysis

Cui, Yuanshan; Zong, Huantao; Yan, Hong; Zhang, Y

doi:10.1038/pcan.2013.60

Cited by 104 publications

(72 citation statements)

References 33 publications

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“…Other data have confirmed these findings and propose a threshold level of approximately 8.6 mmol/l [Rastrelli et al 2013]. Several studies also support the use of testosterone in men 'at risk' for prostate cancer without increasing their baseline odds of prostate cancer development [Roddam et al 2008;Muller et al 2012;Cui et al 2014]. Yet the absence of large, long-term randomized controlled trials precludes a definitive answer and at-risk men should be appropriately screened for prostate cancer prior to initiation of, and at regular intervals, during treatment.…”

Section: Controversies and Risksupporting

confidence: 61%

Testosterone deficiency in the aging male

McBride

Carson

Coward

2015

Therapeutic Advances in Urology

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Treatment for hypogonadism is on the rise, particularly in the aging population. Yet treatment in this population represents a unique challenge to clinicians. The physiology of normal aging is complex and often shares the same, often vague, symptoms of hypogonadism. In older men, a highly prevalent burden of comorbid medical conditions and polypharmacy complicates the differentiation of signs and symptoms of hypogonadism from those of normal aging, yet this differentiation is essential to the diagnosis of hypogonadism. Even in older patients with unequivocally symptomatic hypogonadism, the clinician must navigate the potential benefits and risks of treatment that are not clearly defined in older men. More recently, a greater awareness of the potential risks associated with treatment in older men, particularly in regard to cardiovascular risk and mortality, have been appreciated with recent changes in the US Food and Drug Administration recommendations for use of testosterone in aging men. The aim of this review is to provide a framework for the clinician evaluating testosterone deficiency in older men in order to identify correctly and treat clinically significant hypogonadism in this unique population while minimizing treatment-associated harm.

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Section: Controversies and Risksupporting

confidence: 61%

Testosterone deficiency in the aging male

McBride

Carson

Coward

2015

Therapeutic Advances in Urology

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“…64 Meta-analyses of placebocontrolled T therapy trials have documented no increased risk of PCa in men receiving T therapy. 65 In men who received T therapy, there was no increased risk of high-grade disease. 66,67 Although lowering serum T concentration into the castrate range clearly causes PCa regression and reduces prostate-specific antigen levels, the evidence indicates a limited ability of androgens to stimulate PCa growth, with maximal androgenic stimulation achieved at low T concentrations.…”

Section: Resolution 8 the Evidence Does Not Support Increased Risk Omentioning

confidence: 98%

Fundamental Concepts Regarding Testosterone Deficiency and Treatment

Morgentaler

Zitzmann²,

Traish

et al. 2016

Mayo Clinic Proceedings

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To address widespread concerns regarding the medical condition of testosterone (T) deficiency (TD) (male hypogonadism) and its treatment with T therapy, an international expert consensus conference was convened in Prague, Czech Republic, on October 1, 2015. Experts included a broad range of medical specialties including urology, endocrinology, diabetology, internal medicine, and basic science research. A representative from the European Medicines Agency participated in a nonvoting capacity. Nine resolutions were debated, with unanimous approval: (1) TD is a well-established, clinically significant medical condition that negatively affects male sexuality, reproduction, general health, and quality of life; (2) symptoms and signs of TD occur as a result of low levels of T and may benefit from treatment regardless of whether there is an identified underlying etiology; (3) TD is a global public health concern; (4) T therapy for men with TD is effective, rational, and evidence based; (5) there is no T concentration threshold that reliably distinguishes those who will respond to treatment from those who will not; (6) there is no scientific basis for any age-specific recommendations against the use of T therapy in men; (7) the evidence does not support increased risks of cardiovascular events with T therapy; (8) the evidence does not support increased risk of prostate cancer with T therapy; and (9) the evidence supports a major research initiative to explore possible benefits of T therapy for cardiometabolic disease, including diabetes. These resolutions may be considered points of agreement by a broad range of experts based on the best available scientific evidence.

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“…В крупных проспективных исследованиях долгосрочного на-блюдения не было выявлено корреляции между эндо-генными концентрациями андрогенов и риском рака предстательной железы [64]. В мета-анализах плацебо-контролируемых исследований терапии тестостероном документировано отсутствие увеличения риска рака предстательной железы у мужчин, получающих тера-пию тестостероном [65]. У мужчин, получавших тера-пию тестостероном, отсутствовало увеличение риска рака предстательной железы высокой степени злокаче-ственности [66,67].…”

Section: заявление 8 существующие доказательные данные не подтверждаunclassified

“…Результаты долгосрочных наблюдений говорят об отсутствии зависимости между более высо-кими концентрациями тестостерона сыворотки и риском рака предстательной железы [64]. В мета-анализах не обнаружено увеличение риска рака предстательной железы у мужчин, получавших терапию тестостероном, по сравнению с плацебо [65]. Случаи заболевания с высокой степенью злокачественности и неблагоприятным прогнозом, напротив, коррелируют с низкими концентрациями тестостерона [63].…”

Section: ответы экспертовunclassified

“…[6]. Современные доказательные данные не позволяют говорить об увеличении риска рака предстательной железы у мужчин, получающих терапию тестостероном [65], или у мужчин с более вы-сокими эндогенными концентрациями андрогенов, по сравнению с мужчинами с более низкими кон-центрациями [64]. В действительности же на данный момент растет объем доказательных данных, напро-тив, подтверждающих зависимость между низкими концентрациями тестостерона и неблагоприятными прогностическими признаками рака предстательной железы, высокими показателями по шкале Глисона, а также частотой биохимических рецидивов после хи-рургического лечения [63].…”

Section: ответы экспертовunclassified

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The consensus recommendations of a group of international experts on the fundamental concepts related to the issues of testosterone deficiency and its treatment.

Morgentaler

Абрахам²,

Zitzmann³

et al. 2016

Obes. metabol.

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Conference on the development of the international expert consensus to address frequently asked questions related to a medical condition of testosterone deficiency (TD, male hypogonadism) and testosterone therapy was held in Prague (Czech Republic) on October 1, 2015. The included experts were representatives from a variety of medical specialties, including urology, endocrinology, diabetology, internal medicine, as well as representatives of basic medical sciences. An international team of experts came to the following conclusions: TD - an important medical condition that affects the health and well-being of men; TD symptoms is a consequence of low testosterone levels, regardless of whether background etiology installed; TD consequences are global; care must be taken in an attempt to use any uniform threshold levels of testosterone for a decision on the appointment of testosterone therapy; a person does not have any reason to refrain from appointing testosterone therapy only on the basis of age; the existing evidence does not suggest increasing the prostate cancer or cardiovascular disease risk during testosterone therapy; there is evidence conserning the feasibility of a major research initiative to explore possible cardioprotective beneficial effects of testosterone therapy in men with metabolic disorders, including diabetes.

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The effect of testosterone replacement therapy on prostate cancer: a systematic review and meta-analysis

Abstract: This meta-analysis shows that regardless of the administration method, TRT is the short-term safety and does not promote prostate cancer development or progression but long-term data are warranted with justifiable end points.

Cited by 104 publications

References 33 publications

Testosterone deficiency in the aging male

Testosterone deficiency in the aging male

Fundamental Concepts Regarding Testosterone Deficiency and Treatment

The consensus recommendations of a group of international experts on the fundamental concepts related to the issues of testosterone deficiency and its treatment.

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