<p><a href="https://peterattiamd.com/TedSchaeffer3/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=240722-pod-TedSchaeffer3&utm_content=240722-pod-TedSchaeffer3-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=240722-pod-TedSchaeffer3&utm_content=240722-pod-TedSchaeffer3-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=240722-pod-TedSchaeffer3&utm_content=240722-pod-isaackohane-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>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.</p> <p><strong>We discuss:</strong></p> <ul type="disc"> <li>Background on the TRAVERSE trial: insights into exogenous testosterone and prostate cancer risk [3:00];</li> <li>The androgen receptor saturation theory: how different organs respond to varying levels of testosterone [10:30];</li> <li>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];</li> <li>Using the Decipher score to assess prostate cancer aggressiveness and guide personalized treatment strategies [23:45];</li> <li>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];</li> <li>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</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Consider TRT for Health
If you are symptomatic and hypogonadal, consider testosterone replacement therapy (TRT) to maintain cardiovascular health, bone health, muscle mass, and cognitive function, as the benefits often outweigh the risk of prostate cancer development or detection.
2. Continue TRT with Low-Grade Cancer
If you have a low-grade prostate cancer (e.g., Gleason 3+3) and are on testosterone replacement therapy (TRT), you may continue TRT, as there is no evidence it accelerates or propagates low-grade prostate cancer. This applies even if your testosterone levels are high but within the normal distribution.
3. Surgery to Avoid ADT Morbidity
For higher-grade prostate cancers requiring treatment, consider surgery as a primary option to potentially avoid systemic androgen deprivation therapy (ADT) and maintain testosterone levels for overall health, provided post-surgical pathology is favorable. This is a critical factor when deciding between radiation and surgery.
4. ARA Score for Radiation Therapy
If you have a high-grade prostate cancer and are considering radiation therapy, inquire about your tumor’s ARA score, as a low ARA score may indicate enhanced sensitivity to intensified androgen deprivation therapy (ADT) with newer agents.
5. Decipher for Low-Grade Outliers
If you have a low-grade prostate cancer (e.g., Gleason 3+3) typically managed with surveillance, consider a Decipher score to identify if your tumor is one of the rare aggressive outliers (about 7% of cases).
6. Low T & Aggressive Cancer
Be aware that prostate cancers developing in a low testosterone environment may be more aggressive and less dependent on androgens, making them potentially more challenging to treat if they progress.
7. Monitor PSA on TRT
If you are supplementing with exogenous testosterone, monitor your PSA and its changes, as this can still indicate risk for prostate cancer. Men with low PSAs (around 0.9 ng/mL) generally have a low risk.
8. Radiation Requires Aggressive ADT
If you have a higher-grade prostate cancer (Gleason 7 or higher) and opt for radiation therapy, expect to undergo aggressive androgen suppression as part of the treatment, which will reduce your testosterone to zero.
9. TRT May Worsen BPH
If you are a eugonadal man considering testosterone supplementation, be aware that it may worsen benign prostatic hyperplasia (BPH) or urinary symptoms due to the greater sensitivity of benign prostate cells to exogenous testosterone.
10. Post-Radiation TRT Challenges
If you undergo radiation therapy for prostate cancer, be aware that restarting testosterone replacement therapy afterward may be challenging due to residual benign prostate tissue, which could lead to false positive PSA readings for recurrence.
11. Utilize PSA Biomarker
If you have prostate cancer, understand that PSA is an exquisitely sensitive biomarker that allows for precise monitoring of treatment efficacy and early detection of recurrence, enabling targeted salvage therapies rather than broad adjuvant treatments.
12. Advocate for Liquid Biopsies
If you are a woman with breast cancer, advocate for or stay informed about the development of liquid biopsies and cell-free DNA monitoring, which could enable more targeted therapies and potentially reduce the need for widespread adjuvant anti-estrogen therapy.
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