Testosterone and Prostate Cancer: Insights Beyond Heart Disease

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The Traverse Trial examined whether exogenous testosterone increases the risk of atherosclerotic cardiovascular disease (ASCVD) in men, concluding it does not. While this finding addresses concerns regarding heart disease, it raises additional questions about the relationship between testosterone therapy and prostate cancer. The discussion focuses on the need to further explore the implications of testosterone use in the context of prostate cancer risk, indicating that while ASCVD risk is not elevated, other potential effects on prostate health warrant attention.

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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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