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.

Peter Attia

Jul 22, 2024

Episode description

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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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Mindsip insights from this episode:

Maintain testosterone replacement therapy safely with low-grade prostate cancer

There is no evidence that continuing testosterone replacement therapy (TRT) accelerates low-grade prostate cancer, and it can be safely maintained under surveillance.

#prostate

#TRT

Choose surgery over radiation for high-grade tumor management

For a patient with a certain high-grade tumor profile, surgery may be preferable to radiation to avoid the significant morbidity of systemic androgen deprivation therapy.

#cancer

Utilize PSA biomarker for precise prostate cancer monitoring

Unlike breast cancer, prostate cancer has the highly sensitive PSA biomarker, allowing for a 'sniper' approach to monitoring recurrence rather than a 'bazooka' approach of adjuvant therapy for everyone.

#cancer

#screening

Utilize Decipher score to assess tumor aggressiveness beyond Gleason score

An MRNA-based assay called the Decipher score can analyze a tumor's genetic signature to determine its true aggressiveness beyond the standard Gleason score.

#cancer

#testing

Understand link between low testosterone and aggressive prostate cancer

Paradoxically, lower testosterone levels are associated with more aggressive, high-grade prostate cancers because these tumors are less dependent on androgens for growth.

#cancer

#testosterone

Understand prostate's testosterone saturation point to manage growth risk

The androgen receptors in the prostate can become fully saturated at serum testosterone levels as low as 250 ng/dL, meaning higher levels may not significantly increase prostate growth or cancer risk.

#prostate

#testosterone

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