Prostatitis is a chronic inflammation of the prostate gland that can compromise a man’s quality of life. Naif Alwithanani, from Case Western Reserve University (Ohio, USA), and colleagues studied 27 men, ages 21 years and older, each of whom were diagnosed with prostatitis within the past year (via biopsy and prostate specific antigen [PSA] test). The men were assessed for symptoms of prostate disease by answering questions on the International-Prostate Symptom Score (IPSS) test. Of the 27 participants, 21 had no or mild inflammation, but 15 had biopsy-confirmed malignancies, and 2 had both inflammation and a malignancy. Each of the subjects had at least 18 teeth, and all of them showed moderate to severe gum disease. They received treatment and were tested again for periodontal disease four to eight weeks later and showed significant improvement. During the periodontal care, the men received no treatment for their prostate conditions. But even without prostate treatment, 21 of the 27 men showed decreased levels of PSA. Those with the highest levels of inflammation benefited the most from the periodontal treatment. Six participants showed no changes. Symptom scores on the IPSS test also showed improvement. The study authors write that: “Periodontal treatment improved prostate symptom score and lowered PSA value in men afflicted with chronic periodontitis.”

Article Source: http://www.worldhealth.net/news/poor-oral-health-may-signal-prostate-issues/

Examination of a national health database failed to find a relationship between testosterone replacement therapy (TRT) and prostate cancer risk. In fact, over the long term, a reduction in the risk of aggressive prostate cancer was observed in men treated with TRT, similar to previous observations.

The analysis uncovered a halving of the risk of aggressive prostate cancer with TRT when used for more than 1 year compared with controls. The findings were presented by Stacy Loeb, MD, from the New York University Langone Cancer Center, New York City, at the 2016 annual meeting of the American Urological Association.

The study population consisted of 38,570 prostate cancer cases diagnosed between 2009 and 2012 from the National Prostate Cancer Register of Sweden. Serving as controls were 192,838 men matched on birth year and place of residence. These databases were linked to the Prescribed Drug Register of Sweden, which allowed the researchers to obtain information on the type, dose, and duration of TRT.

Of the 38,570 prostate cancer cases, 284 had used testosterone at some point before their prostate cancer diagnosis. Of the men with prostate cancer, 59% had favorable disease and 38% had aggressive disease. Of the 192,838 controls, 1,378 had used testosterone. The median age was 69 years in both groups.

No association was found between TRT and the overall risk of prostate cancer when adjusted for comorbidity, marital status, and level of education.

“The type of testosterone didn’t matter,” said Loeb. “We looked at whether they used gel, injections, or other types, and there was no difference in prostate cancer risk based on the mode of administration.”

When examined by risk group, TRT users had an increased risk of being diagnosed with favorable prostate cancer (OR 1.35, 95% CI 1.16-1.56). The greatest risk of being diagnosed with favorable disease occurred within the first year of TRT use, which suggests detection bias, she said, since guidelines in Sweden recommend enhanced screening for prostate cancer during the first year of TRT use.

TRT was associated with a 50% reduction in the risk of aggressive prostate cancer, “and this became much stronger and significant in long-term use,” similar to the findings in other series, she said.

Speculating on the mechanism behind the large reduction in risk of aggressive disease with long-term TRT use, Loeb pointed to a large body of literature that suggests that hypogonadal men have more aggressive disease. Activation of prostate tumor-promoting pathways and genetic changes have been observed in a low testosterone environment, she said.

“We hypothesize that for these men, restoring them back to normal testosterone levels may mitigate the risk of what seems to be a more aggressive phenotype of tumors developing in a low testosterone environment.”

Ahmad Haider, MD, a urology and andrology specialist in Bremerhaven, Germany, and colleagues also found that TRT in hypogonadal men does not increase the risk of prostate cancer. His group looked at registry data from 656 symptomatic hypogonadal men (total testosterone levels ≤348 ng/dL) with a mean age of 61 years. Some 360 men received parenteral testosterone undecanoate, dosed at 1,000 mg/12 weeks following an initial 6-week interval, for up to 10 years. The other 296 men who opted against TRT served as controls.

Both groups were followed for a mean of 78.0 months. The proportion diagnosed with prostate cancer over this time was 1.9% in the TRT group and 4.1% in the controls. The incidence of prostate cancer per 10,000 patient years was found to be 31 in the TRT group compared with 64 in controls. Of those in the TRT group who developed prostate cancer, 100% had a Gleason score ≤3, compared with only 25% of the controls, again suggesting a more severe phenotype without TRT. Two-thirds of untreated controls who had prostate cancer had Gleason 4 disease, and 42% had positive surgical margin, noted Haider.

A third study confirmed the lack of relationship between TRT and incident prostate cancer in hypogonadal men, this one an analysis of U.S. veterans reported by Thomas J. Walsh, MD, at the University of Washington in Seattle.

Almost 15,000 U.S. veterans with laboratory-defined low testosterone formed the study population. Some 40% of the men received either intramuscular TRT, topical TRT, or both. Sixty percent received no testosterone treatment. The median follow-up for the entire cohort was 3 years.

About 1% of the men were diagnosed with prostate cancer, and of these, 22% were aggressive cancers. The incidence of all prostate cancer per 1,000 person-years was 2.52 in the men treated with TRT and 2.78 in those not treated.

The adjusted risk of all prostate cancer was not significantly different between treated and untreated men (HR 0.90, 95% CI 0.81-1.10), and neither was the risk of aggressive prostate cancer (HR 0.89, 95% CI 0.70-1.13). The results did not change significantly when assessing TRT by the formulation of testosterone.

“I would not look at this and say there is a protective effect of testosterone,” said Walsh. “I think there is evidence for absence of risk, but I would not call this evidence of protection.”

Article Source: http://www.medpagetoday.com/meetingcoverage/aua/57881

A newly released study suggests that prolonged treatment may be the key to reducing the serious health risks commonly associated with testosterone replacement therapy .

The controversial treatment is aimed at increasing testosterone levels among men who are lacking the hormone. The supplements can be administered as skin patches, gels, implants or injections.

But the safety of hormone replacement therapy has come into question in recent years, with several studies suggesting sudden spikes in testosterone levels may increase the risk of heart attack, stroke and prostate cancer.

In March of 2015, the U.S. Food and Drug Administration (FDA) agency placed heart attack and stroke warning label warnings on testosterone supplements.

But the new study, authored by Dr. Robert Nam at the Sunnybrook Health Sciences Centre in Toronto, suggests the length of the treatment — and not the drugs themselves — may be the key to making it safe.

Nam’s study followed 38,000 men with low testosterone . It found that those who had got the lowest doses of the hormone showed higher rates of heart attacks and strokes in their first two to three months of treatment. The therapy, however, had the opposite effect on those who continued to receive the treatment for three to five years.

“Men on it for at least five years have that protective effect, so it is important to take it for a long time,” Nam said.

The study could help men who would benefit from testosterone replacement by abating some of their worries about the controversial treatment.

And men like Stephen – a patient who says his hormone deficiency was making him sluggish — have seen the benefits of the treatment first-hand.

“More men will feel better,” he said. “It’s not going to make you superman, but it sure helps.”

Nam said the study will help doctors determine whether testosterone replacement therapy is appropriate for their patients.

It also emphasizes the need to closely monitor patients who have just started the treatment.

But the findings may also compromise a number of class-action lawsuits launched throughout Canada and the United States by men who claim they’re been harmed by the treatment.

But lawyer Jill S. McCartney said: “There’s constantly more questions being answered, more research to be done,” she said. “It’s a moving target.”

Low testosterone affects about 20 per cent of men over the age of 60 and about half of men over 80.

The study was conducted by a group of physicians from Ontario healthcare facilities, including Sunnybrook Health Sciences Centre and Mount Sinai Hospital, and highlighted at a American Urological Association meeting in San Diego. The study was funded by the Physicians’ Services Incorporated Foundation and Ajmera Family Chair in Urologic Oncology.

Article Source: http://www.ctvnews.ca/health/long-term-treatment-key-to-safe-testosterone-replacement-therapy-study-1.2893711

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A new large-scale population-based study from The University of Texas Medical Branch at Galveston showed for the first time that older men using testosterone therapy were less likely to have complications that require them to go back to the hospital within a month of being discharged than men not using this therapy. The study is currently available in Mayo Clinic Proceedings .

Using nationally representative SEER-Medicare linked data, the researchers identified 6,372 men over 66 with low testosterone who were hospitalized at least once between January 2007 and December 2012. The distribution of age, ethnicity/race and marital status were comparable between testosterone users and nonusers.

The study analyzed data to determine the patients’ risk of going back to the hospital within 30 days after hospital discharge. The older men receiving therapy for low testosterone were less likely to return to the hospital. The overall rate of 30-day hospital readmissions was 9.8 percent for testosterone users and 13 percent for non-users. This decline was stronger for emergency readmissions, with a rate of 6.2 percent for testosterone users and 10 percent for non-users.

“It is possible that our findings of decreased hospitalization among male Medicare beneficiaries who received testosterone therapy reflect the improved health, strength and exercise capacity seen in previous studies,” said lead author Jacques Baillargeon, UTMB professor of epidemiology in the department of preventative medicine and community health. “Our findings suggest that one of the benefits of androgen therapy may be quicker recovery from a hospital stay and lower readmission rates. Given the importance of potentially avoidable hospital readmissions among older adults, further exploration of this intervention holds broad clinical and public health relevance.”

Reducing avoidable hospital readmissions is a national health priority and a major focus of health care reform in the United States. When older persons go home after a stay in the hospital, many are less independent and have poorer day-to-day health. Previous studies have confirmed that age-related loss of muscle mass and strength is hastened by hospital stays and leads to higher rates of rehospitalizations, admission to long-term care facilities and death.

Testosterone deficiency is associated with muscle loss and overall health decline, rendering older men with low testosterone particularly vulnerable to “post-hospital syndrome.” Testosterone therapy, which increases muscle mass and strength, is reported to improve mobility, functional health and exercise capacity in older men with low testosterone.

Other authors of this paper include UTMB’s Rachel Deer, Yong-Fang Kuo, Dong Zhang, James Goodwin and Elena Volpi. This research was supported by the National Institutes of Health and the Agency for Healthcare Research and Quality.

Article Source: http://www.eurekalert.org/pub_releases/2016-04/uotm-ttd041316.php

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Kevin T. Nead and colleagues evaluated medical records from the Stanford health system and New York’s Mount Sinai Hospital for 16,888 nonmetastatic prostate cancer patients, of whom 2,397 received androgen deprivation therapy. Men treated with androgen deprivation therapy for various lengths of time were matched with control patients who did not receive the ther­apy. Researchers discovered that men who received the therapy were 88% more likely to develop Alzheimer’s over follow-up. Longer androgen depriva­tion therapy duration (equal to or greater than 12 months) was associated with more than double the risk of developing Alzheimer’s.

Editor’s Note: “Based on the results of our study, an increased risk of Alzheimer’s disease is a potential adverse effect of androgen deprivation therapy, but further research is needed before considering changes to clinical practice,” Dr. Nead noted. It is regrettable that this therapy must be employed to save the lives of certain prostate cancer patients. These findings help reinforce a strategy that men with advancing prostate cancer who need to block testosterone production should consider intermittent androgen deprivation therapy, in which therapy is stopped after the PSA falls to a low level, usually after 3-9 months. Androgen deprivation therapy is resumed only if the PSA increases significantly. By carefully monitoring PSA blood levels, androgen deprivation can often be used sparingly to control PSA levels while maintaining quality of life.