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| |  Low Testosterone Levels in Men May Mask Presence of Prostate Cancer BOSTON, Dec. 17, 1996 -- Two standard screening tests for prostate cancer may be unable to detect the presence of the disease in a significant number of middle aged-men with low levels of the male hormone testosterone, according to a new study in the December 18 Journal of the American Medical Association (JAMA) by researchers at Beth Israel Deaconess Medical Center. Since testosterone can cause growth of an unsuspected prostate tumor, the study authors recommend that men age 50 and older who are considering testosterone replacement therapy have a biopsy first since a digital rectal exam (DRE) or PSA (prostate specific antigen) test alone may miss the presence of early, hard-to-detect cancers. "In the group of men we studied, all of whom had low testosterone and all of whom had normal screening tests for prostate cancer, the incidence of cancer was significant -- 14 percent overall, and 29 percent for men over 60," says Abraham Morgentaler, MD, Director, Male Infertility and Impotency Program at Beth Israel Deaconess Medical Center and principal author of the JAMA study, "Occult Prostate Cancer in Men with Low Serum Testosterone Levels." "Men have been treated with testosterone for decades, but I think our study will cause some rethinking about the use of testosterone," says Dr. Morgentaler. The new study may have serious implications for men with sexual dysfunction since the male hormone testosterone is commonly used to treat this condition, an increasingly common medical problem as men age. Dr. Morgentaler and his colleagues studied 77 men with low levels of testosterone and found that 11 of the men had prostate cancer. Needle biopsies under transrectal ultrasound guidance were used to detect the cancers. All the cancers were found in men who had normal DRE and PSA, according to Morgentaler. All the men in the five-year, retrospective study had been referred to Beth Israel Deaconess Medical Center. The authors suggest that since PSA levels may be altered by the natural drop in testosterone levels associated with aging, and because of concerns that testosterone replacement therapy may promote the growth of prostate cancer in men at increased risk, doctors may want to perform needle biopsies to rule out cancer in middle-aged or older men considering testosterone replacement therapy. "While there's no evidence that testosterone causes prostate cancer, treatment with testosterone has the potential to cause prostate cancer to grow more rapidly," says Morgentaler. "The youngest of the men with prostate cancer was 52 years old, with the remainder older than 60. Six of the men had surgery, and a significant amount of cancer was found in their prostates. If standard screening techniques had been used, 11 of these men would have received testosterone, with possible progression of their cancer," adds Morgentaler. The researchers believe that low testosterone levels falsely lower PSA and shrink prostate cancers, so that these tumors are more difficult to detect. The PSA test is an easy blood test to administer that is used to detect and monitor problems of the prostate. It is estimated that prostate cancer will be diagnosed in more than 318,000 men this year, according to the American Cancer Society. Co-authors of the JAMA study, "0ccult Prostate Cancer in Men with Low Serum Testosterone Level," include Dr. William DeWolfe of Beth Israel Deaconess Medical Center and Dr. Carl Bruning of the University of Pittsburgh. Beth Israel Deaconess Medical Center, Boston, is a major teaching affiliate of Harvard Medical School. Beth Israel Deaconess Medical Center is a founding member of CareGroup, an organized system of healthcare delivery serving the individual, family, and community.
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