The Response of Metastatic Adenocarcinoma of the Prostate to Exogenous Testosterone

Abstract

In a retrospective review the response of 67 patient with metastatic adenocarcinoma of the prostate to the administration of exogenous testosterone was analyzed. Among 52 patients in whom objective and/or subjective responses were evaluable 45 experienced unfavorable responses. There was prompt regression of most unfavorable responses with testosterone withdrawal. The duration of treatment required to evoke an unfavorable response was related to the clinical status of the patient. Twenty-five per cent of patients with symptomatic metastases who had received no prior treatment, 36 per cent in symptomatic remission after endocrine therapy and 94 per cent with symptomatic relapse after endocrine therapy experienced unfavorable responses within 30 days of treatment. No patient had objective evidence of tumor regression during testosterone therapy but 7 patients, 6 with remission and 1 untreated, experienced symptomatic benefit. We conclude that the response of patients with metastatic prostate cancer to exogenous testosterone is related to the mass and endocrine treatment status, and that exogenous testosterone can stimulate prostatic neoplasms that proliferate in the absence of normal endogenous testosterone levels.

Differential androgen receptor signals in different cells explain why androgen-deprivation therapy of prostate cancer fails

“…Fowler and Whimore, (1981) observed that out of 52 metastatic prostate cancer patients who received ART, 45 exhibited increased cancer progression that could be reversed by androgen withdrawal, whereas 7 experienced symptomatic benefits. Other investigators have observed that in patients with castration-resistant metastatic prostate cancer, ART resulted in either little adverse effect on cancer progression or displayed some biochemical improvement or progression (Mathew, 2008;Morris et al, 2009;Szmulewitz et al, 2009).…”

Serum Testosterone, 17β-Estradiol and PSA Levels in Subjects with Prostate Disorders

“…A potential risk of testosterone therapy is an increased incidence of prostate cancer. Whereas androgen depletion hinders the development and clinical progression of prostate cancer, exogenous testosterone may stimulate growth of metastatic prostate cancer [14,15]. Testosterone appears to be an independent predictor of disease and enhances the predictive accuracy for BPH [16].…”

Correlation between simultaneous PSA and serum testosterone concentrations among eugonadal, untreated hypogonadal and hypogonadal men receiving testosterone replacement therapy

“…[1][2][3] More contemporary clinical trials have shown little, if consistent evidence of a carcinogenic influence or the tendency to 'unmask' subclinical prostate cancer when TRT is prescribed to otherwise healthy hypogonadal men. [4][5][6] On the basis of lingering concerns and uncertainly, coupled with the fact that the prostate is known to be a androgensensitive organ, most evidence-based clinical guidelines recommend close surveillance of the prostate with prostate-specific antigen (PSA) and digital rectal examination among men treated with TRT.…”