Tuesday, September 11, 2012

Future Trends in Reducing the Risk of Prostate Cancer in Men Receiving TRT


Several studies have utilized the combination of a chemoprevention agent with TRT to reduce the risk of prostate cancer. Page et al. conducted a 36-month trial in which they randomized 70 men with low serum testosterone (<350 ng/dl) to receive one of three regimens: intramuscular testosterone enanthate 200 mg every 2 weeks plus daily placebo pills; intramuscular testosterone enanthate 200 mg every 2 weeks plus finasteride 5 mg/day; or placebo injections plus pills. The study rationale was to try and decrease the level of DHT while achieving the benefits of TRT on overall quality of life. The investigators reported no increase in prostate cancer risk in any of the groups. In an earlier study in the same men, Amory et al. reported that, compared with TRT alone, TRT plus finasteride had an attenuating effect on prostate volume and PSA. It is difficult to draw strong conclusions based on the small number of patients and the relatively short follow-up duration in these studies. Furthermore, the PCPT suggested that the use of finasteride may be associated with more aggressive cancer. Nevertheless, a recent review suggests a benefit to reducing death, factoring in the potential risk of higher Gleason scores in men receiving finasteride.Its widespread use as a chemoprevention agent is not currently recommended. Future larger trials need to be performed to assess the use of dietary manipulation (e.g. lycopene, vitamin E, selenium) and other chemopreventive agents. Until the association between testosterone and prostate cancer risk has been further clarified in large, long-term, controlled studies, caution should be exercised and rigorous selection and monitoring guidelines should be adhered to before initiating TRT in older men.

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