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Rapidly Shifting Concepts Regarding Androgens and Prostate Cancer

There has been a recent dramatic shift in our understanding of the relationship between androgens and prostate cancer (PCa). Whereas for several decades it had been assumed that higher serum testosterone (T) concentrations would lead to ever-greater PCa growth, current literature indicates that PCa...

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Autor principal: Morgentaler, Abraham
Formato: Online Artículo Texto
Lenguaje:English
Publicado: TheScientificWorldJOURNAL 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823199/
https://www.ncbi.nlm.nih.gov/pubmed/19649507
http://dx.doi.org/10.1100/tsw.2009.80
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author Morgentaler, Abraham
author_facet Morgentaler, Abraham
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description There has been a recent dramatic shift in our understanding of the relationship between androgens and prostate cancer (PCa). Whereas for several decades it had been assumed that higher serum testosterone (T) concentrations would lead to ever-greater PCa growth, current literature indicates that PCa growth is unaffected by changes in serum T throughout most of the naturally occurring range. A Saturation Model has been proposed to explain how prostate tissue can be exquisitely sensitive to changes in serum T at the very low end of the concentration range, but appears indifferent to such changes above the near-castrate range. This has special applicability to T-deficient men, since this means that T therapy may not be nearly as risky as once assumed. Indeed, one of the more interesting changes over the last several years has been the growing acceptance of the use of T therapy in men with a prior history of PCa, with early data indicating minimal risk of cancer recurrence or progression. Provocative new evidence suggests that it is not high serum T that is problematic for PCa, but low serum T that is associated with worrisome cancer features and outcomes, such as high Gleason score, advanced stage of presentation, and increased risk of biochemical recurrence after surgery. It will be interesting to see what changes will occur in this rapidly changing field over the next several years.
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spelling pubmed-58231992018-03-14 Rapidly Shifting Concepts Regarding Androgens and Prostate Cancer Morgentaler, Abraham ScientificWorldJournal Review Article There has been a recent dramatic shift in our understanding of the relationship between androgens and prostate cancer (PCa). Whereas for several decades it had been assumed that higher serum testosterone (T) concentrations would lead to ever-greater PCa growth, current literature indicates that PCa growth is unaffected by changes in serum T throughout most of the naturally occurring range. A Saturation Model has been proposed to explain how prostate tissue can be exquisitely sensitive to changes in serum T at the very low end of the concentration range, but appears indifferent to such changes above the near-castrate range. This has special applicability to T-deficient men, since this means that T therapy may not be nearly as risky as once assumed. Indeed, one of the more interesting changes over the last several years has been the growing acceptance of the use of T therapy in men with a prior history of PCa, with early data indicating minimal risk of cancer recurrence or progression. Provocative new evidence suggests that it is not high serum T that is problematic for PCa, but low serum T that is associated with worrisome cancer features and outcomes, such as high Gleason score, advanced stage of presentation, and increased risk of biochemical recurrence after surgery. It will be interesting to see what changes will occur in this rapidly changing field over the next several years. TheScientificWorldJOURNAL 2009-07-27 /pmc/articles/PMC5823199/ /pubmed/19649507 http://dx.doi.org/10.1100/tsw.2009.80 Text en Copyright © 2009 Abraham Morgentaler. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Morgentaler, Abraham
Rapidly Shifting Concepts Regarding Androgens and Prostate Cancer
title Rapidly Shifting Concepts Regarding Androgens and Prostate Cancer
title_full Rapidly Shifting Concepts Regarding Androgens and Prostate Cancer
title_fullStr Rapidly Shifting Concepts Regarding Androgens and Prostate Cancer
title_full_unstemmed Rapidly Shifting Concepts Regarding Androgens and Prostate Cancer
title_short Rapidly Shifting Concepts Regarding Androgens and Prostate Cancer
title_sort rapidly shifting concepts regarding androgens and prostate cancer
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823199/
https://www.ncbi.nlm.nih.gov/pubmed/19649507
http://dx.doi.org/10.1100/tsw.2009.80
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