cover of episode #310 - The relationship between testosterone and prostate cancer, testosterone replacement therapy, and tools for predicting cancer aggressiveness and guiding therapy | Ted Schaeffer, M.D., Ph.D.

#310 - The relationship between testosterone and prostate cancer, testosterone replacement therapy, and tools for predicting cancer aggressiveness and guiding therapy | Ted Schaeffer, M.D., Ph.D.

2024/7/22
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Peter Attia：探讨了Traverse试验的结果，该试验旨在研究外源性睾酮对男性ASCVD和前列腺癌风险的影响。试验结果显示外源性睾酮不增加ASCVD风险，但对前列腺癌的影响仍存在不确定性。 Ted Schaeffer：详细解释了Traverse试验的结果，指出该试验中低PSA的低睾酮男性补充睾酮后，前列腺癌诊断率并未增加。PSA变化可作为监测指标。基于Traverse试验和其他研究，他认为将低睾酮男性补充至正常水平睾酮，不会增加前列腺癌发生或发展风险。他进一步解释了雄激素受体饱和度理论，指出不同器官对睾酮的敏感性不同，前列腺组织对睾酮的敏感度相对较低，补充睾酮对前列腺癌影响有限。他详细阐述了高等级前列腺癌与较低睾酮水平的相关性，以及高侵袭性肿瘤雄激素受体活性较低，依赖不同的生长机制的现象。他介绍了Decipher检验及其在评估前列腺癌侵袭性方面的作用，以及如何利用Decipher评分指导前列腺癌的治疗决策，尤其是在Gleason评分较高的患者中，可辅助决定是否进行更积极的治疗，如强化雄激素剥夺疗法。他还讨论了在低级别前列腺癌患者中，无论是否进行睾酮替代疗法，治疗方案应一致；对于高级别前列腺癌，手术可能优于放疗联合雄激素剥夺疗法，以避免雄激素剥夺疗法的副作用。最后，他还比较了前列腺癌和乳腺癌的治疗策略差异，并展望了液体活检技术在未来乳腺癌治疗中的应用前景。 Ted Schaeffer: 对Traverse试验结果进行了深入解读，强调试验样本量有限，难以得出确切结论。他认为，将低睾酮男性补充至正常水平睾酮，不会增加前列腺癌的发生或发展风险。他详细解释了雄激素受体饱和度理论，指出不同器官对睾酮的敏感性不同，前列腺组织对睾酮的敏感度相对较低，补充睾酮对前列腺癌的影响有限。他还讨论了高等级前列腺癌与低睾酮水平的相关性，以及高侵袭性肿瘤对雄激素依赖性较低，依赖不同生长机制的现象。他介绍了Decipher检验及其在评估前列腺癌侵袭性方面的应用，以及如何利用Decipher评分指导治疗决策。他强调，对于低级别前列腺癌患者，即使进行睾酮替代疗法，也不需要停止治疗。对于高级别前列腺癌患者，他建议根据具体情况选择手术或放疗，并尽可能避免雄激素剥夺疗法带来的副作用。

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Ted Schaeffer is an internationally recognized urologist specializing in prostate cancer and a returning guest on The Drive. In this episode, Ted provides insights into the role testosterone plays, or doesn't play, in the initiation and progression of prostate cancer. He unpacks the findings and limitations of the recent TRAVERSE trial, exploring the complex relationship between testosterone and prostate cancer. Ted delves into the molecular nature of prostate cancer, explaining the androgen receptor saturation theory and the potential impact of testosterone on cancer growth. He also discusses the use of the Decipher test to predict cancer aggressiveness and guide targeted treatment. Furthermore, Ted shares how he counsels patients regarding testosterone replacement therapy (TRT), including its safe administration in patients with low-grade prostate cancer. Additionally, he highlights advancements in prostate cancer therapies and biomarkers that help develop precise treatment strategies while minimizing the need for broad androgen deprivation therapy.

We discuss:

  • Background on the TRAVERSE trial: insights into exogenous testosterone and prostate cancer risk [3:00];
  • The androgen receptor saturation theory: how different organs respond to varying levels of testosterone [10:30];
  • The relationship between testosterone levels and prostate cancer aggressiveness: how aggressive prostate tumors have lower androgen receptor activity and rely on different growth mechanisms [16:15];
  • Using the Decipher score to assess prostate cancer aggressiveness and guide personalized treatment strategies [23:45];
  • Considerations for testosterone replacement therapy: how Ted counsels patients, how TRT can be safely administered in patients with low-grade prostate cancer, and more [31:15];
  • Advancements in prostate cancer therapies and PSA as a biomarker for precise treatment decisions, minimizing the need for broad androgen deprivation therapy [38:30]; and
  • More.

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