#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.

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Jul 22, 2024

Ted Schaeffer, an esteemed urologist and chair of the Department of Urology at Feinberg School of Medicine, breaks down the nuances of testosterone and its impact on prostate cancer. He discusses insights from the TRAVERSE trial, revealing that testosterone replacement therapy may not significantly increase cancer risk. Schaeffer also explores the androgen receptor saturation theory and introduces the Decipher test for predicting cancer aggressiveness. He shares advancements in precision medicine, emphasizing tailored treatment strategies to optimize patient outcomes.

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INSIGHT

TRAVERSE Trial and Prostate Cancer

The TRAVERSE trial studied if testosterone replacement therapy (TRT) increases prostate cancer risk in hypogonadal men.
It found no significant increase in prostate cancer diagnoses in men on TRT versus placebo.

INSIGHT

Testosterone Saturation in Prostate Tissue

Prostate tissue, unlike muscle, becomes saturated with testosterone at low levels (around 250 ng/dl).
This suggests that higher testosterone levels may not significantly impact prostate growth beyond this point.

INSIGHT

Testosterone and Prostate Cancer Aggressiveness

Lower testosterone levels may correlate with a higher risk of high-grade prostate cancer.
Aggressive prostate tumors rely less on androgens for growth, using different pathways.

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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
More.

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