Prostate Cancer: Lowering Testosterone Levels May Not Be Good Option

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Prostate cancer
Prostate cancer is sometimes treated by lowering testosterone, however, a recent study has suggested that this treatment may not be a good option. Lowering testosterone is officially called androgen-deprivation therapy and it is more often used for localized prostate cancer in older patients. The study was carried out at the Rutgers Cancer Institute and was published in the journal JAMA Internal Medicine.

The study looked at long-term survival in patients that had their testosterone levels lowered as a treatment for prostate cancer. A total of 66,717 Medicare patients who were 66 years or older were included in the study. The study used previously published information regarding areas in the U.S. in which the testosterone therapy was used more extensively and areas in which it was more seldom used.

The standard for grading prostate tumors has been set by the American Joint Commission on Cancer and was used in the study to group participants. The grading system scores tumors as well differentiated, to moderately differentiated, to poorly differentiated, to undifferentiated as a scale going from low grade to high grade tumors. A high grade tumor has more serious consequences.

Men who had moderately differentiated cancers had a 15-year overall rate of 20.8 percent in areas with low use of testosterone therapy and  a 20.0 percent overall survival rate in areas with high use of testosterone therapy; while the cancer-specific 15 year survival rate was 90.6 in both high and low use areas. For men with poorly differentiated cancers, the 15-year overall survival rate was 8.6 percent in high use areas and 9.2 percent in low use areas; and the 15-year cancer-specific survival rate was 78.6 percent in high use areas and 78.5 in low use areas. Comparisons of the percentages for 15-year survival rates showed that lowering testosterone levels did not aid with longer survival.

The outcome of the study is significant in showing that lower testosterone levels do not work as a treatment for prostate cancer. Given the serious side effects that come from lowering testosterone levels, this is an important finding for clinicians. Side effects include higher risk of bone fractures, hot flashes, impotence, higher risk for diabetes and heart disease. When men are put on a testosterone lowering treatment, they are usually kept on this therapy for life. This means that they are not living with the side effects for a short period of time but for a very long time. It has been reported that some physicians have strongly stated that there is no compelling evidence to justify using this therapy.

Prostate cancer is the second most common cancer among men, only skin cancer occurs more often. It has been reported that over two million men in the United States are prostate cancer survivors. One of the messages from this study report is the importance of  considering all treatment options when facing prostate cancer. Even though testosterone lowering therapy for prostate cancer has been used regularly and many men have been receiving this therapy, it may not be the best option for everyone.

By Margaret Lutze

JAMA Internal Medicine
New York Times
Health Central