Raynaud Jean-Pierre
Université Pierre & Marie Curie, 4 Place Jussieu, Paris, France.
J Steroid Biochem Mol Biol. 2009 Mar;114(1-2):96-105. doi: 10.1016/j.jsbmb.2009.01.014. Epub 2009 Jan 30.
Testosterone deficiency syndrome (TDS) can be linked to premature mortality and to a number of co-morbidities (such as sexual disorders, diabetes, metabolic syndrome, ...). Testosterone deficiency occurs mainly in ageing men, at a time when prostate disease (benign or malign) start to emerge. New testosterone preparations via different route of administration appeared during the last decade allowing optimized treatment to these patients. One potential complication of this treatment is the increased risk of prostate and breast cancer. Consequently, the guidelines from the agencies and the institutions, the recommendations of the scientific expert committees and the attitude of the clinicians to who, when and how to treat hypogonadal patients, is very conservative, not to say, highly restrictive. To date, as documented in many reviews on the subject, nothing has been found to support the evidence that restoring testosterone levels within normal range increases the incidence of prostate cancer. In our experience, during a long-term clinical study including 200 hypogonadal patients receiving a patch of testosterone, 50 patients ended 5 years of treatment and no prostate cancer have been reported. In fact, the incidence of prostate cancer in primary or secondary testosterone treated hypogonadal men is lower than the incidence observed in the untreated eugonadal population. However, even if the number of patients treated in well-conducted clinical trials for whom cancer of the prostate has been reported is insignificant (a very few), the observed population is still too small to raise definite conclusions. Low testosterone levels have been reported in patients undergoing radical prostatectomy and the outcomes are of worse diagnostic in this population; at a later stage, testosterone deficiency can be induced by anti hormonal manipulation of patient with a prostate cancer, leading to the symptoms of hypogonadism. The question is to know whether it is justified, in case of profound symptoms, to supplement those patients with testosterone. Some attempts have been made and the results are encouraging: so it is time to re-examine our position and to question about the definite recommendation that patients with prostate cancer should never receive testosterone supplementation therapy; this is already the situation when intermittent androgen blockade is initiated if the biological response is satisfactory. Furthermore, it has been advocated that, under a rigorous surveillance, patients cured of prostate cancer can be treated with testosterone supplementation with beneficial results.
睾酮缺乏综合征（TDS）与过早死亡及多种合并症（如性功能障碍、糖尿病、代谢综合征等）有关。睾酮缺乏主要发生在老年男性中，此时前列腺疾病（良性或恶性）开始出现。在过去十年中出现了通过不同给药途径的新型睾酮制剂，使这些患者能够得到优化治疗。这种治疗的一个潜在并发症是前列腺癌和乳腺癌风险增加。因此，各机构和组织的指南、科学专家委员会的建议以及临床医生对于何时、如何治疗性腺功能减退患者的态度都非常保守，可以说是高度限制的。迄今为止，正如许多关于该主题的综述所记载的那样，没有发现证据支持将睾酮水平恢复到正常范围会增加前列腺癌发病率这一观点。根据我们的经验，在一项长期临床研究中，包括200名接受睾酮贴片治疗的性腺功能减退患者，其中50名患者完成了5年治疗，未报告前列腺癌病例。事实上，原发性或继发性接受睾酮治疗的性腺功能减退男性中前列腺癌的发病率低于未治疗的性腺功能正常人群中观察到的发病率。然而，即使在进行良好的临床试验中报告患有前列腺癌的治疗患者数量很少（极少数），观察到的人群仍然太小，无法得出明确结论。据报道，接受根治性前列腺切除术的患者睾酮水平较低，且该人群的诊断结果较差；在后期，前列腺癌患者的抗激素治疗可导致睾酮缺乏，从而引发性腺功能减退症状。问题在于，对于症状严重的患者，补充睾酮是否合理。已经进行了一些尝试，结果令人鼓舞：因此，是时候重新审视我们的立场，并质疑前列腺癌患者绝不应该接受睾酮补充治疗这一明确建议了；如果生物学反应令人满意，间歇性雄激素阻断治疗时已经是这种情况。此外，有人主张，在严格监测下，治愈前列腺癌的患者可以接受睾酮补充治疗并取得有益效果。
