Testosterone may increase PSA level

Dear Dr. Roach: Fifteen years ago, I had a successful brachytherapy treatment for prostate cancer. Subsequent annual PSA results indicate minimal levels. I am 82 years old and in otherwise excellent condition, and generally very active. However, in the past few years I have had periods of considerable fatigue. My blood counts are within the normal range, but my testosterone is at a very low level. My family physician counsels against testosterone therapy because of the possibility of reigniting prostate cancer. This seems to be based on a long history of a causal relationship.

A senior fitness trainer at my squash club argues that quality of life is important, so I should try testosterone therapy and then watch my PSA levels carefully. He says this because there have been a number of more recent trials in which there seemed to be a changing view that there is no definite connection that testosterone therapy causes new cancer. He has several clients who have found renewed energy from testosterone therapy. I have reviewed endless articles on the topic, but find nothing definitive. What’s your opinion? The fatigue is troublesome.

R.T. Answer: The reason you aren’t finding any definitive articles is that there are no well-done studies looking at people with a history of prostate cancer being treated with testosterone. There are some data, however. A

2013 review looked at seven studies with a total of about

200 men with a history of prostate cancer treated with testosterone. Only one had an increase in PSA level suggesting recurrence; most men were able to get normal testosterone levels, and most but not all had improvement in symptoms.

My own practice is to consider a trial of testosterone replacement in men who are thought to be cured of prostate cancer based on very low or nondetectable PSA levels, who have symptoms that are very consistent with low testosterone and who have a low level on laboratory testing.

If the symptoms are bad enough to be worth a small risk of cancer recurrence, and for a patient who is able to weigh those risks himself and chooses to, I have cautiously prescribed testosterone.

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