The two chief, adverse outcomes from treatment that men diagnosed with prostate cancer most often confront are erectile dysfunction (ED) and urinary incontinence (UI). Even a year following a prostatectomy, or surgical removal of the prostate gland, 40-50% of patients are confronted with ED and 5-20% face some degree of daily UI. For addressing the UI, there are pelvic floor muscle exercises (also essential for attaining and maintaining strong erections until climaxing), male sling surgery, and artificial urinary sphincter implants. There are also, of course, adult absorbent products and other collection and containment devices strictly for management. For the ED, there are medications, vacuum pumps, and penile implants.
Now, despite the strongly held belief that testosterone therapy in men previously diagnosed with prostate cancer is improper and ill-advised, there is evidence that attitudes about this are changing. Urologist Abraham Morgentaler, MD, at Harvard Medical School and author of Testosterone for Life published by McGraw-Hill in 2009, has written about encouraging results he’s experienced in treating men with a history of prostate cancer. Dr. Morgentaler writes, admittedly with limited evidence of his own, that raising low levels of testosterone does very little to affect the growth of prostate cancer or cause the cancer to resurface. The FDA still requires all testosterone products to include the warning that it is contraindicated in men with a prior history of prostate cancer.
Testosterone, a hormone produced by the body, is transported in the bloodstream like insulin. It has three basic functions: 1) fetal development of the male reproductive organs; 2) prostate growth; and 3) male pattern baldness. For this reason, the drug, known as Proscar ®, or finasteride, is used for reducing the size of an enlarged prostate in cases of non-cancerous growth of the prostate and is marketed in a different dosage as Propecia ® to promote new hair growth in men with baldness. As men age, their testosterone levels naturally decline and are likely to be even lower in men with diabetes, obesity, high blood pressure, or lung disease.
Both sexual and non-sexual symptoms of low testosterone are experienced by men and can be confirmed by blood tests. Sexual symptoms include low sex drive, ED, and difficulty achieving orgasm. Non-sexual symptoms include increased chronic fatigue, loss of motivation in general, a negative mood, and lack of vigor. There is no evidence that over the counter supplements and natural therapies, despite their claims, offer any help to men with low testosterone. Physical exercise, however, can raise levels in younger men.
Bottom line, low levels of testosterone do not protect against prostate cancer, nor do high levels increase its risk. Treatment with testosterone does not increase the risk of prostate cancer, even those at high risk for other reasons. However, men with a metastatic prostate given other hormones to drop their blood levels of testosterone to near zero could increase the growth of cancer if commencing testosterone therapy. Be aware of long held myths and understand both the functionality and limitations of testosterone.