#310 - The relationship between testosterone and prostate cancer, testosterone replacement therapy, and tools for predicting cancer aggressiveness and guiding therapy | Ted Schaeffer, M.D., Ph.D.
Internationally recognized urologist Ted Schaeffer discusses the complex relationship between testosterone and prostate cancer. He explains the androgen receptor saturation theory and the use of the Decipher test for predicting cancer aggressiveness. Ted also touches on safe testosterone replacement therapy administration and advancements in prostate cancer therapies.
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Quick takeaways
Testosterone replacement therapy impact on prostate cancer risk was inconclusive in the TRAVERSE trial.
Decipher test aids in predicting prostate cancer aggressiveness and tailoring treatment strategies effectively.
Deep dives
The Traverse Trial and Testosterone
The Traverse trial aimed to investigate if exogenous testosterone use increased the risk of ASCVD in men. The study examined hypogonadal men and their testosterone supplementation, finding a small increase with a 60% dropout rate. The focus was on the impact of supplementing endogenous testosterone with exogenous testosterone on the risk of developing or progressing in prostate cancer.
The Prostate Cancer Risk from Traverse Study
The Traverse study showed that supplementing testosterone did not result in more diagnosed prostate cancers compared to placebo. It reassured that men with low PSA levels had a low risk of prostate cancer diagnosis. The study indicated that monitoring PSA levels could help assess the risk of developing prostate cancer in men undergoing testosterone supplementation.
Saturation Theory and Androgen Receptors
The saturation theory suggests that once a certain level of androgens within an organ, like the prostate, is reached, additional testosterone may have limited effects. The study integrates how different levels of testosterone impact various end organs like muscle and the central nervous system. Supplementation effects differ based on the saturation levels of the androgen receptor within each organ.
Link Between Testosterone and Prostate Cancer Treatment
For lower-grade tumors, like Gleason 3 plus 3, testosterone supplementation management focuses on maintaining health without significant changes. In higher-grade prostate cancer cases, decisions revolve around the necessity of aggressive androgen suppression or surgical intervention based on the tumor's aggressiveness and potential recurrence rates. Monitoring PSA levels and molecular characteristics play crucial roles in treatment decisions.
Ted Schaeffer is an internationally recognized urologist specializing in prostate cancer and a returning guest on The Drive. In this episode, Ted provides insights into the role testosterone plays, or doesn't play, in the initiation and progression of prostate cancer. He unpacks the findings and limitations of the recent TRAVERSE trial, exploring the complex relationship between testosterone and prostate cancer. Ted delves into the molecular nature of prostate cancer, explaining the androgen receptor saturation theory and the potential impact of testosterone on cancer growth. He also discusses the use of the Decipher test to predict cancer aggressiveness and guide targeted treatment. Furthermore, Ted shares how he counsels patients regarding testosterone replacement therapy (TRT), including its safe administration in patients with low-grade prostate cancer. Additionally, he highlights advancements in prostate cancer therapies and biomarkers that help develop precise treatment strategies while minimizing the need for broad androgen deprivation therapy.
We discuss:
Background on the TRAVERSE trial: insights into exogenous testosterone and prostate cancer risk [3:00];
The androgen receptor saturation theory: how different organs respond to varying levels of testosterone [10:30];
The relationship between testosterone levels and prostate cancer aggressiveness: how aggressive prostate tumors have lower androgen receptor activity and rely on different growth mechanisms [16:15];
Using the Decipher score to assess prostate cancer aggressiveness and guide personalized treatment strategies [23:45];
Considerations for testosterone replacement therapy: how Ted counsels patients, how TRT can be safely administered in patients with low-grade prostate cancer, and more [31:15];
Advancements in prostate cancer therapies and PSA as a biomarker for precise treatment decisions, minimizing the need for broad androgen deprivation therapy [38:30]; and