Testosterone therapy and the prostate

view presentation | view presentation transcript | view curriculum vitae | print this page

Professor Dieter Jocham, MD and Christian Doehn, MD, Department Of Urology, University Of Schleswig-Holstein (UKSH) Campus Lubeck Medical School, Lübeck, Germany

Background: The physiological role of testosterone with respect to various conditions like prostate growth, benign prostatic hyperplasia (BPH) and prostate cancer is presented. Also the issue of testosterone substitution concerning BPH and prostate cancer as well as the role of the androgen receptor and effects of 5-alpha reductase inhibitors are discussed.

Physiology and pathophysiology: The prostate size increases by 1.6% per year. There is no difference in testosterone levels between men with and without BPH. However, men with lack of testosterone will not develop BPH and men with low testosterone will achieve normal prostate size under testosterone substitution. Men with prostate cancer have no abnormal hormonal levels like testosterone, dihydrotestosterone, free testosterone, sexual hormone binding globulin as well as oestradiol, cortisol and others compared to men without prostate cancer. The androgen receptor is regulated via various mechanisms like androgen receptor binding, protein stability, modulation of gene expression and other mechanisms. Mutation of the androgen receptor (e.g. shortening of the CAG-triplet-repeat) results in activation of the receptor by "peptide growth factors" (e.g. EGF, IGF-1). Therapy with 5-alpha reductase inhibitors like finasteride or dutasteride result in a reduction of prostate size as well as PSA. 

Testosterone substitution and conclusions: Testosterone with therapeutic intent has got a relatively high range. At present the negative effects of testosterone substitution seem to be without major consequences for the male patient. However, the recommendation is to use preparations with a short half-life and short intervals of patients' examination.