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Man Must Decide If Testosterone Supplement Is Worth Risk of Prostate Cancer Recurrence

Valley News - 6/17/2018

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. This may be different for males who have not had a previous history of prostate cancer. What’s your opinion? The fatigue is troublesome, and I would like to try testosterone but not at a real risk of setting myself back 15 years. — R.T.

Answer: I am glad your prostate cancer seems to be in remission. Brachytherapy is the use of implanted radiation “seeds” or “pellets” to destroy prostate cancer cells.

I can’t recommend a course of action that your own physician has counseled against, as he or she may have more information about you than I do.

The reason you aren’t finding any definitive articles is that there are no well-done scientific 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. Fatigue is a common symptom in men with low testosterone but is not specific for low testosterone. Many conditions can be associated with fatigue.

My own practice, in consultation with the patient’s urologist, 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 (and often physical exam findings) that are very consistent with low testosterone and who have a low level on laboratory testing. I agree that PSA levels (along with a history and physical exam) should be checked carefully.

Ultimately, it is a balance of risks. 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.

Dear Dr. Roach: I have always heard that breakfast is the most important meal of the day. I never eat breakfast. Most times I eat just once a day, at dinnertime – and no, I don’t pig out then, either. I have boneless, skinless chicken breast or pork chops baked or on the grill, with a boxed pasta side dish, and I feel just fine and have lost weight. I call it the once-a-day diet. If this works, and I can eat just once a day, then I think it’s fine and easy to do once you get used to it. — R.G.

Answer: While I’m glad this diet has helped you lose weight, my experience is that many people who eat only once daily have problems with weight gain, probably because they are so hungry that they consume more calories than they need. Breakfasts help many people with energy during the day and keep them from getting so hungry that they make poor choices. However, eating large meals less frequently is a successful strategy for some people.

However, I can’t agree with your overall food choices. You haven’t mentioned any fruits or vegetables, whole grains, legumes or nuts, and these are the basis for a healthy diet, in my opinion. Your diet is deficient in many micronutrients (such as vitamin C and calcium), so I hope you just neglected to mention these and actually are consuming some. A diet that helps a person lose weight is great, but a diet for optimizing overall health is different from what you are reporting. A nutritionist or your doctor can provide more information.

Dear Dr. Roach: Could you find out what the success rate of laser treatment for vaginal rejuvenation for incontinence is? I find the wearing of adult diapers unattractive and unsatisfactory, but I would rather not waste my money on a procedure that has not been proven successful. — B.M.

Answer: There are several types of incontinence (the most common are urge incontinence, the sense that you need to get to the bathroom RIGHT AWAY or else will have an accident, and stress incontinence, when urine leaks with a stressful maneuver, such as a cough or a sneeze). The best treatment depends on the type of incontinence, and before considering a treatment like laser, it’s important to look carefully at common causes, including medications, underlying medical conditions, urine infection and vaginal atrophy. These may have effective treatments. Even if no cause can be identified, pelvic floor muscle exercises and bladder training still may be effective. Medications and pessaries are helpful for some women.

If you have been through all of these and are still having incontinence, then it is worthwhile to consider options, including surgery in some cases. Laser vaginal treatment is a potential new treatment. Several preliminary studies have been done, showing 60 to 80 percent effectiveness, but I still think it is too early to recommend this treatment.

Readers may email questions to ToYourGoodHealth@med.cornell.edu .

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