Evidencias actuales acerca de la relación entre el tratamiento de reemplazo hormonal en el síndrome del déficit de testosterona y el cáncer de próstata

Abstract

Epidemiologic studies show an age-related decrease of testosterone (T), associated to different symptoms, which constitute the testosterone deficiency syndrome (TSD). Although the effectiveness of the testosterone replacement treatment (TRT) in these patients has been well demonstrated, it continues existing a certain fear for its application due to concepts of the past that pointed the possibility that TRT favored the development or acceleratIon of a hidden prostate cancer (CaP). Present studies demonstrate the lack of relationship between the plasmatic levels of T and CaP, being some indications of a greater prevalence of this pathology in patients with very low levels of T. The CaP in these patients usually is more severe according to the score of Gleason, they appear at a more advanced stage and have a worse survival. Prostate histologic studies in TRT patients demonstrate that significant differences do not exist in terms of testicular histology, tisular biomarkers and neoplasic incidence when it is compared with placebo.The prevalence of CaP in hypogonadic patients in TRT is similar to the one of the general population in the same range of age (1%). TRT increases the PSA and the prostate volume at the same value of the eugonadics.On the basis of the security that offers TRT in hypogonadic patients, it has been tried in short series of patients with localized CaP who underwent either radical prostatectomy or braquiterapy, without tumor recidives.In spite of all the referred one, TRT is totally contraindicated in patients with a non-trated CaP.As a conclusion, it can be stated that every day there are greater evidences to lose the fear to the TRT in patients with SDT, being fundamental the quarterly control during the first year and later annual by means of the PSA and the digital examination.