Wouldn’t it be great if you could have your cake and eat it too? That’s not something that usually happens. But when it comes to treating prostate cancer, that’s exactly what a new study says.
The study shows that men being treated for prostate cancer by being deprived of testosterone can also have testosterone.
In fact, the results show that this revolutionary method of treatment might even be better than what is currently done, especially for your sex drive.
Prostate cancers are stimulated by the hormone testosterone. So, one of the most common ways to treat it is to deprive a man with prostate cancer of the hormone. The name of this approach is androgen deprivation therapy or ADT. ADT can be done with surgery, but is usually done with drugs that either decrease the levels of testosterone or render the testosterone unable to work by blocking its receptors. No matter how the man’s testosterone levels are dealt with, the end results of ADT are three: (1) The prostate cancer will initially stop growing and then shrink. (2) The man will have all of the undesirable and unhealthy results of not having any testosterone. (3) The prostate cancer will eventually learn how to grow with even very low levels of testosterone and the therapy will no longer work.
The reason why ADT stops working after a while has to do with the testosterone receptors on the cancer cells. Testosterone receptors consist of molecules on the surface of the cancer cells that testosterone can react with to stimulate the cells to grow. The more receptors a prostate cancer cell has, the more testosterone will stimulate its growth. And here’s the problem. When doctors give men ADT and knock out their testosterone, the cancer cells respond by increasing their receptors. In fact, they can increase the receptors so much that no matter how much ADT is given, the cells will still be able to get enough testosterone to grow. And this is why ADT eventually fails. But what if there was a way to stop the increase in receptors? Well, there is.
When doctors give a man with prostate cancer a very high dose of testosterone, the cancer cells respond by decreasing their receptors. It’s easy to understand why this would happen. When the cancer cells see how high the testosterone levels have become, they decrease the number of their receptors because with these high levels they need only a few receptors. So, with this in mind, it might make sense to alternate between giving a man with prostate cancer a very high dose of testosterone to decrease the receptors and then giving him a course of ADT once the receptors are low. In this scenario two things could happen. One, when the receptors are low the testosterone-lowering effects of the ADT will be more effective. Two, since the man is getting some testosterone, he will be much less likely to suffer from all of the significant side effects of ADT and will have a much better quality of life. All of these effects are beneficial. But that’s not all that can happen.
It turns out that although prostate cancer cells are stimulated by normal levels of testosterone, extremely high levels of testosterone have a totally different effect. Extremely high levels of testosterone actually cause prostate cancer cells to go into apoptosis. That means that they die! This is especially true when they have very high levels of receptors. That’s because the more receptors there are, the more sensitive the cancer cells are to the hormone. And that’s the secret behind this new form of prostate cancer therapy. When a man is given ADT, the result is that the prostate cancer cells dramatically increase the number of receptors. And it’s at that point that the cancer is extra vulnerable to super high doses of testosterone. So, when the doctor follows a course of ADT by a course of high-dose testosterone, the result could be a better cancer die off. But does it really work? That’s what one group of researchers set out to discover. They call the therapy Bipolar Androgen Therapy.
The researchers looked at 26 men with prostate cancer, many of whom had serious disease. Almost all of them had cancers that were a Gleeson score of 7 or higher. Cancers with scores higher than 7 are the most aggressive forms of prostate cancer. The average PSA level was 27, and some of the men had levels over 250. And in most of these men, the cancer had already spread to the bones. They gave the men ADT for the next 18 months. At the six-month point, their PSA tests were all less than 4 – indicating a very positive response to ADT.
Then at the six-month point, the researchers gave each of the men an injection of 400 mg of testosterone. This was a high enough dose to bring their blood testosterone levels way over the normal range. They repeated the injections two more times spaced 28 days apart. After these initial three injections, the next three months the men received only the ADT. And then they had another three-month series of treatments with the testosterone injections. Here’s what happened at the end of the 18 months of treatment.
Most of the men (59%) had a PSA less than 4, indicating complete control of their cancers. This includes some of the men who had PSA levels over 100 at the beginning of the study. And 10% had a PSA level that was undetectable. One man appeared to have been completely cured by the treatments because even after three months of stopping all therapy, his PSA level was still undetectable. These results are much better than what’s typically seen with ADT. And here’s something really important. ADT usually causes men to be weak, have little to no sex drive, become impotent, and have low energy. This was the case with these men also in the first six months of ADT only. But all that changed when they started getting the testosterone. Once they had the testosterone, the quality of life scores went up in all of the men.
Because of the significant difference in results in each of the men in this study, it’s hard to predict who will have the best results with this new method. But two points stand out. One, considering the fact that many of the men in this study had very advanced disease, the fact that 59% had PSA levels less than 4 after 18 months is remarkable. Two, the most undesirable aspects of ADT are the side effects and quality of life issues. And every one of the men improved in that area once they started having the testosterone injections.
So, if you have prostate cancer and are about to start ADT, make sure you have a conversation with your doctor about this new study. Especially if your quality of life is going down. At the same time, as I have reported to you in the past, it’s critically important that men on ADT engage in resistance training at least three hours each week. That, combined with the testosterone injections, will do a lot to prevent muscle and lean body tissue loss.
Yours for better health,
Frank Shallenberger, MD
REF: Schweizer MT, Wang H, t al. Bipolar Androgen Therapy for Men With Androgen Ablation Naïve Prostate Cancer: Results From the Phase II BATMAN Study. Prostate. 2016 Sep;76(13):1218-26.