Prostate Cancer: Key Facts
Prostate cancer is the most commonly diagnosed cancer among men. In the UK alone, over 50,000 men are diagnosed with prostate cancer each year, and approximately 12,000 succumb to the disease. Despite these numbers, many men live with prostate cancer without it causing significant problems. Remarkably, over 78% of men diagnosed with prostate cancer in the UK survive beyond 10 years.
Risk factors include family history and ethnicity, with Black men and those with a family history of prostate cancer being at a higher risk. Additionally, the likelihood of developing prostate cancer increases with age. Men under 45 generally have a very low risk, but awareness should increase after the age of 45, especially around 50 and beyond.
The Role of PSA Testing
The Prostate-Specific Antigen (PSA) test is a blood test used to help detect prostate cancer. However, it is not infallible. Around 75% of men with elevated PSA levels (above 3) do not have prostate cancer, and some men with normal PSA levels may still develop the disease. Elevated PSA can result from various factors, including recent physical activity or sexual activity, which is why it is advised to avoid vigorous exercise and sexual activity for 48 hours before the test.
While the PSA test can indicate the need for further investigation, such as ultrasound or MRI, it has its limitations. The advent of advanced MRI techniques has decreased the need for invasive prostate biopsies by approximately 25% in recent years.
Testosterone Replacement Therapy and Prostate Cancer Risk
There is ongoing debate about whether testosterone replacement therapy might increase the risk of prostate cancer. Since treatments for prostate cancer often involve reducing testosterone levels, it is reasonable to question whether increasing testosterone might elevate cancer risk. However, current evidence suggests that testosterone replacement therapy does not significantly increase the risk of prostate cancer.
Studies and guidelines from urological and sexual medicine experts indicate that testosterone therapy does not correlate with an increased risk of prostate cancer. Research shows that the prostate becomes saturated with testosterone at levels around 8-8.5 nmol/L, and increasing testosterone beyond this threshold does not further elevate prostate testosterone levels.
It is possible that men with total testosterone levels below 8.5 nmol/L may experience a rise in PSA levels when starting testosterone therapy. This could potentially unmask latent prostate cancer that was previously asymptomatic. Data from the Testosterone Trials in the USA revealed that 4.4% of men on testosterone experienced a rise in PSA requiring urological evaluation, compared to 1.7% in the placebo group. Among those who underwent biopsy, a higher proportion in the testosterone group were found to have prostate cancer, including some high-grade cases.
Key Takeaways
- There is no conclusive evidence linking testosterone replacement therapy to an increased risk of prostate cancer.
- However, it is prudent for men over 50 to have their prostate examined and monitored before starting testosterone therapy. Regular PSA tests should be conducted at 3, 6, and 12 months after beginning treatment, and annually thereafter.
- Discussing PSA monitoring and potential risks with a healthcare provider is advisable for anyone considering testosterone replacement therapy.
Understanding these aspects of prostate cancer and testing can help in making informed decisions about health and treatment options. Regular monitoring and consultation with healthcare professionals are essential in managing and mitigating risks effectively.
