people always want to know does testosterone cause prostate cancer well today I'm going to answer that for good I'm Dr Reena Malik eurologist and pelvic surgeon today I'm going to share with you data from the Traverse trial that looked at prostate safety in men getting testosterone replacement now this is really exciting because this is the largest randomized control trial that we have today looking at testosterone replacement therapy and specifically looking at safety now I've talked about this before I'm looking at the safety of testosterone therapy in patients who have cardiovascular health issues or health concerns and so this new data is specifically looking at prostate cancer concerns as well as symptoms related to an enlarging prostate or lower urinary tract symptoms you may not know but prostate cancer is hormonally sensitive so often we treat patients who have prostate cancer with medications that decrease your testosterone level now but does that mean that if you don't have prostate cancer giving you testosterone is going to cause prostate cancer now even before this study came out many of us would say no that doesn't make any sense right but now we have concrete data there's also a concern that giving testosterone can cause worsening of urinary symptoms because it may cause prostate growth now as I discussed previously on my video looking at natural ways to reduce enlarge prostate while prostate growth is related to to hormones particularly when you're going through aging through your teenage years and up to you're a young adult your prostate is very hormonally sensitive and you need testosterone for it to grow to mature size but as men age their testosterone decreases and their prostate continues to grow so that theory doesn't really have legs but based on this data I can now tell you does testosterone increase your risk of prostate cancer make your urinary symptoms worse or increase the size of your prostate well let's get into it so this study looked at over 5,000 men who were on average 63 years of age and had either pre-existing cardiovascular disease or had an increased risk of cardiovascular disease because it was initially designed to look at cardiovascular outcomes now these men were then randomized to either receive testosterone replacement in the form of a gel that you put on your arm your buttock or your abdomen daily or get no testosterone replacement or meaning a placebo gel now in order to be defined as being hypogonadal or having low testosterone they had to have testosterone levels of below 300 on two separate blood draws as well as symptoms of low testosterone that can be symptoms like having fatigue low energy erectile dysfunction low libido decreased muscle mass increased fat or even depression so they could about any of those symptoms and as well as low testosterone as defined on blood work now they testost cids were followed or they were required to maintain levels between 350 N per deiler to up to 750 nog per des lator and the primary end point meaning what they powered the study to look at was highgrade prostate cancer meaning that men who had a glein score of 4 plus three or higher now prostate cancer is very slow growing and we know that lower grades of prostate cancer are less likely to become metastatic or problematic and so this is why they chose high-grade prostate cancer which is really the concerning prostate cancer to choose their primary outcome now their secondary outcome was any prostate cancer as well as urinary retention needing some sort of invasive prostate procedure having new pharmacologic intervention for prostate or getting a prostate biopsy to assess for prostate cancer now when they were deciding about prostate biopsies they had very specific guidelines on who to refer for biopsies and this is because when we think about giving testosterone if you have low testosterone particularly around below 240 230 your testosterone or endogen receptors are not fully saturated so giving testosterone is going to get all those receptors saturated and you will see an increase in PSA so then you can imagine the researchers didn't want everyone who got testosterone to refer anyone with a slight bump just to get a biopsy because that's not really realistic right and based on prior studies we're seeing that if men go from about 240 to about 500 you're seeing an increase in PSA by about 47 at 12 months so again this is confirmed in data so basically if they had an increase from Baseline of 1.4 nanograms per milliliter or more they were considered for a prostate biopsy or over four if they were not taking any medications over two if they were taking medications like finasteride or dutasteride that can decrease your PSA by half or if they were below 55 and their PSA went above three those were all indications for biopsy if they felt a nodule at any time that was also indication for biopsy and if they felt any sort of induration now these patients who met these criteria were asked to watch a video about PSA screening and prostate biopsy and then they were asked if they wanted to proceed with prostate biopsy now this is completely by the guidelines because there's so much information to understand about PSA screening and deciding to go ahead with biopsy it is a shared decision-making model meaning we share this information with you and you decide if you want to proceed because we know that prostate cancer is extremely slow growing and that if you are say within 10 years of the end of your life that likely something else will cause your demise over prostate cancer we actually stop screening for people who have less than 10 years of life and so it's really a very sort of controversial topic and important to discuss with your doctor and in detail now these men were followed for on average 33 months so that's a pretty long time 92% made it to a full year 74% to about 2 years and 57% to about 3 years and it dropped off quite precipitously at 4 years and so what they found was that the incidence of highgrade prostate cancer in the active group meaning the ones that got testosterone replacement and those that didn't was very very similar it was 0.19% and 0.12% so I'm going to show you guys what the results are here on this graph now this is called a forest plot it's that line down the middle if you cross that line that means that your data is not significant it means that it's Crossing it can be it can be favorable or not favorable and so you can see that at all the end points including high-grade prostate cancer any prostate cancer urinary retention needing a procedure having pharmacologic intervention and getting a b SE there was no significant difference between people who got trt and people who didn't now I will say the caveat that I explained to you how these men got biopsied so in these 5,000 men they saw about 85 with elevated PSA that met criteria now only a small subset of them in both groups went on to get the biopsy now this is again why I explain the nuances of shared decisionmaking so only less than 20% in each group went on to get biopsy so ultimately the good news is if you're taking testosterone replacement or considering taking testosterone replacement it does not increase your risk of prostate cancer or high-grade prostate cancer and it does not increase your risk of having urinary complications needing a procedure for uh your prostate needing medication or having an issue where you can't urinate and need a catheter so that is really reassuring and again provides really important safety data on testosterone replacement if you want to learn more about testosterone replacement check out my prior videos on testosterone replacement we even have a podcast episode with Dr Jonathan clavell where we talk about tasin replacement you might enjoy that as well and as always we going to take care of yourself because you're worth it