TESTOSTERONE REPLACEMENT - PREVENTS HIGH GRADE PCA

 The theory that testosterone causes PCA has been thoroughly debunked. In fact, one study of men diagnosed with PCA found that those who had the most aggressive, high grade disease also had the lowest blood free testosterone levels. This would suggest testosterone replacement starting in middle age and continued on into old age will prevent the formation of high grade PCA at the least, and may prevent its occurrence, although there is insufficient data to prove that yet. Monitoring estradiol levels starting in middle aged would also seem to be an essential part of PCA prevention as elevated levels are commonly seen in men with low testosterone levels and contribute to benign prostate hypertrophy and perhaps PCA.

 Since the failed DHT blocking drug trials showed that lowering DHT levels encourages a higher grade of PCA, it makes sense that testosterone replacement which will increase DHT levels will have the opposite effect, namely preventing high grade PCA. In men who have undergone prostatectomy for PCA, those with lower levels of testosterone at the time of surgery have more metastasis and have higher Gleason scores.  Thus it seems possible that testosterone replacement will become a routine therapy given to all men as a primary prevention for PCA, or prevent its recurrence in those already diagnosed with PCA.

  In fact, the current prohibition against testosterone replacement in men with PCA may be a false paradigm. A review article published in the January 2013 issue of the Journal of Urology reported on 111 PCA men treated with testosterone replacement .Only 2 (1.8%) of these men showed a recurrence of PCA.. At least five studies published between 1943 -1974 found intramuscular injections of testosterone propionate improved 43 - 74% of men with diagnosed PCA. This was a short-acting form of testosterone commonly used in that era that results in quicker clearance of testosterone from the body. Longer acting forms such as testosterone cypionate used currently may well show better results, but have not been studied in the rush to androgen blocking drugs that create castrate levels of testosterone, a strategy that seems questionable in light of these recent findings.