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Androgens, the prostate and safety of testosterone treatment.

Feneley, MR; Carruthers, ME; (2006) Androgens, the prostate and safety of testosterone treatment. Aging Male , 9 (1) 4-.

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Abstract

Introduction: For patients taking testosterone supplementation, clinical concern relates to the progress of undiagnosed prostate cancer or its development with advancing age. The historical basis for concerns of prostate cancer will be considered in relation to contemporary clinical practice and concepts of prostate cancer biology, both of which have advanced considerably within the PSA era. The role of androgens and androgen signalling pathways in the normal prostate, and changes acquired with benign hyperplasia or malignant transformation will be discussed.Methods: An updated analysis from the UK Andropause Study (UKAS) of 1,650 men on testosterone treatment for up to 15 years, will be presented. All patients underwent at least annual monitoring by digital rectal examination (DRE) and PSA; abnormal findings or rising PSA were further investigated by transrectal ultrasound and prostate biopsy.Results:13 cases of prostate cancer were diagnosed by prescreening (0.5%), and 12 new cases occurred during 2,300 man-years of treatment, all being clinically localized. Irrespective of the hormone preparation, no significant effect on total PSA, free PSA or total/free PSA ratio was detected. Similarly, there was no significant change in urinary symptoms or renal function, in spite of wide variations in endocrine profiles with different testosterone preparations.Conclusions: Prostate cancer is an uncommon but important diagnosis in men receiving androgen replacement therapy. Before commencing treatment, patients should be advised of the interaction between undiagnosed prostate cancer and androgens, as well as the increasing risk of developing prostate cancer with advancing age. Men at risk of androgen deficiency should have prostate monitoring, as several lines of evidence suggest that reduction of physiological androgen activity within the prostate may increase the risk of a more aggressive phenotype. This study confirms the importance of PSA testing and screening for prostate cancer, and assuring prostate health in men recieving testosterone replacement.

Type: Article
Title: Androgens, the prostate and safety of testosterone treatment.
Keywords: Androgen, androgen deficiency, ANDROPAUSE, Biopsy, cancer, deficiency, Development, diagnosis, endocrine profile, Health, hormone, Hyperplasia, Prostate, Prostate Biopsy, prostate cancer, PSA, rectal, renal, Risk, Safety, Screening, Symptom, symptoms, Testosterone, testosterone replacement, ultrasound, Phenotype, methods, analysis, renal function, 15 year, monitoring, therapy, Age, Androgens, normal prostate, MEN, DIGITAL RECTAL EXAMINATION, TRANSRECTAL ULTRASOUND, BIOPSIES
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: http://discovery.ucl.ac.uk/id/eprint/177824
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