DEAR DR. GOTT: Some doctors and urologists say that high testosterone levels contribute to prostate cancer and some say that low testosterone is the culprit. What do you think about this? Is there conflicting research or no research?
I was diagnosed with prostate cancer in 2006 and at that time had a Gleason score of eight. I was treated with brachytherapy, external radiation and Lupron. Both my PSA and testosterone levels became negligible. I’ve been off the Lupron for about 18 months and my testosterone is back up to about 500 and my PSA is just now beginning to rise to 0.2. I understand that this rise in the PSA could be either due to the prostate cancer returning or just due to the normal regrowth of the prostate after being shrunk by the Lupron and low testosterone. I also understand that low testosterone levels may not only contribute to the prostate cancer but the other effects of low testosterone on a man will probably kill him before the cancer does, not to mention what the quality of life is to be neither male nor female, including hot flashes day and night, sleep loss, bone loss, muscle loss, fat gain, low libido, depression, etc. Should I get back on the Lupron which would eliminate my testosterone again? What would you do?
Any further information or sources of information regarding this would be appreciated. Thank you for your column and advice. I look forward to it every morning!
DEAR READER: The prostate is a small-walnut shaped gland present only in men. It is responsible for producing seminal fluid which transports and nourishes sperm. Cancer of this gland is the second leading cause of cancer death in men.
Early stages of prostate cancer may not cause signs or symptoms, but as it advances difficulty urinating, bone pain, blood in the urine and/or semen, swelling of the legs, pelvic discomfort, and a decreased force of the urine stream may develop.
A PSA test measures the level of prostate-specific antigen. High levels can indicate infection, cancer, inflammation, and more. A Gleason score is a test to determine how aggressive the cancer may be. A score of two to four indicates low grade cancer, five to seven indicates intermediate grade and is the most common, and a score of eight to ten indicates high grade cancer. You scored an eight placing you in this category. This implies that the cancer cells are more aggressive, increasing the risk that the cancer has or may spread to surrounding tissue or lymph nodes.
Very early stages may not require treatment. Prostate cancer is normally slow growing and the risks of treatment may outweigh the immediate risks of cancer. “Watchful waiting” may be recommended for those without symptoms or those with other, serious health problems or advanced age which can make treatment more difficult.
There are a variety of treatments available should the cancer be advanced, cause troublesome symptoms, or worsen. These include radiation, hormone therapy, chemotherapy, surgical removal of the prostate, and more.
There are two types of radiation used. The first is external beam radiation which targets the prostate through the skin. The second is brachytherapy which involves surgically implanting rice-sized radioactive seeds into the prostate near the cancer.
Hormone therapy involves stopping the body’s production of testosterone through surgical removal of the testes or the use of medication (such as the Lupron you recently used) or by using medication to block it from reaching the cancer cells. Prostate tumors need testosterone in order to grow so by depriving it, the tumor will shrink.
Chemotherapy for prostate cancer is much the same as it is for other cancers and is often used only when the cancer has spread to distant areas of the body or fails to respond to hormone therapy.
Surgical removal of the prostate (radical prostatectomy) also involves removing some of the nearby tissue and lymph nodes. There are several ways in which this can be done. The procedure isn’t recommended for all prostate cancer patients and carries the risk of erectile dysfunction (ED) and urinary incontinence.
Now to your concerns about testosterone. As I stated above, testosterone is necessary for tumor growth so reducing levels can slow or prevent further growth. To the best of my knowledge low levels of testosterone have not been associated with increased risk of prostate cancer, but then again, high levels of natural testosterone have not been associated with increased risk either. Scientists currently do not know what the long-term risks of hormone replacement therapy for men are and therefore, do not recommend testosterone replacement in men with prostate cancer.
Low levels of testosterone have, unfortunately, been associated with early death, most often cardiac related, in individuals with other risk factors such as high cholesterol, high blood pressure, being overweight, having excess abdominal fat and more. In these men, it’s not known whether replacement decreases that risk, but lifestyle and dietary changes can increase natural testosterone levels. Other effects of low testosterone include ED, hot flashes, loss of muscle and bone mass, and more.
You had a very high Gleason score and your PSA is again rising. This may be, as you pointed out, an indicator that the cancer is returning. You don’t provide your age, cancer stage, or other pertinent information, so I can only urge you to speak with your urologist. He or she is familiar with your situation and can offer you the most appropriate advice for your particular case.
Readers who are interested in learning more can order my Health Report “The Prostate Gland” by sending a self-addressed, stamped, number 10 envelope and a $2 US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from my website’s direct link, www.AskDrGottMD.com/order_form.pdf.
