AB12. Testosterone and prostate cancer: adding fuel to the fire?

Over the last 15 years there has been growing recognition of the benefits of testosterone supplementation therapy (TST) for men with testosterone deficiency (TD), also termed hypogonadism. These benefits include improved sexual interest and performance, improved mood, energy, increased muscle and bone density, decreased fat, and possibly improved longevity. The new interest in TST has precipitated re-examination of traditional assumptions regarding the relationship between testosterone (T) and prostate cancer (PCa), leading to a fundamental paradigm shift. This shift is at odds with longstanding beliefs, and has resulted in controversial new practices, such as offering TST to men with PCa. The belief that androgens cause de novo prostate cancer or accelerate its growth has been called the androgen hypothesis. The androgen hypothesis arose from reports beginning in the 1940s in which men with metastatic prostate cancer demonstrated clinical and biochemical improvement with androgen deprivation via castration or estrogen treatment, and conversely demonstrated rapid PCa progression with T administration. Medical students and physicians have been taught for years that high T promotes the development of PCa, low T is protective, and the administration of T to a man with existing PCa is like “feeding a hungry tumor,” or “pouring gasoline on a fire.” An international survey revealed that the most common concern about TST among physicians is the risk of PCa.