Use of testosterone in men with prostate cancer and suggestions for an international registry.

TLDR: These examples suggest a host of possible and person-specific responses of the benign and malignant prostate gland to its androgen milieu.

Abstract: B J U I N T E R N A T I O N A L © 2 0 11 B J U I N T E R N A T I O N A L | 1 0 7 , 1 3 4 3 – 1 3 4 6 | doi:10.1111/j.1464-410X.2011.10236,10226.x 1 3 4 3 Few issues in men’s health are as controversial and fraught with misinformation as the diagnosis and treatment of testosterone deficiency syndrome, which can develop with advancing age. As pointed out in the MiniReview in this issue of BJUI [1], the relationship between the prostate gland and gonadal steroids (both androgens and oestrogens) is not simple or black and white but is subtle, complex and incompletely understood. This complex relationship is illustrated by the following: (i) the dependence, to a large extent, of the cellular response to gonadal hormones on the CAG repeat polymorphism of the androgen receptor (AR) [2]; (ii) the finding that the prostate responds differently to testosterone and dihydrotestosterone (DHT) – higher levels of the former prevent enlargement of the gland, while the latter stimulates it [3]; and (iii) the significant variation in response to testosterone administration among individuals depending on age, body composition, testosterone-binding protein levels, doses of the hormone reached and the person’s aromatase activity with differential oestrogen:testosterone ratios [4]. These examples suggest a host of possible and person-specific responses of the benign and malignant prostate gland to its androgen milieu.