Prostate cancer and testosterone: has orthodox medicine got it wrong?

Prostate cancer and testosterone: has orthodox medicine got it wrong?

Increasingly research shows that prostate cancer has little to do with levels of testosterone and far more to do with levels of estrogen in men; but this runs counter to the history and current treatment of prostate cancer; could this be the reason for the poor statistics on the disease?

The alarming growth of prostate cancer

The numbers of men dying from prostate cancer in the UK has hit an all time record at over 12,000 in 2017. According to Prostate Cancer UK, one of the three main reasons is the increased incidence of the cancer returning unexpectedly. Why, you might ask, would this be happening?

Actually, the question of whether orthodox medicine might not be wonderfully effective was put into sharp focus by an Oxford University study in 2016. Professor Freddy Hamdy and his team concluded that there is 'Absolutely no survival advantage in having orthodox medical treatment for a newly diagnosed prostate cancer patient after 50 years of age (4)". You might think that he might have done something wrong in research, but actually it was the fifth study and by far the largest study of its kind!

Back in 2006, I turned down an article for icon magazine. It was an interview with the head of prostate cancer at a leading cancer hospital in London. In this he said that prostate cancer was "all about high testosterone levels and how they found that giving people high doses of oestrogen, the female sex hormone, would cut testosterone and increase survival times". I used to joke in speeches around the world, that if prostate cancer were all about high testosterone levels, then every 18 year old boy would have the disease.

Fortunately in 2020, we don't throw high doses of oestrogen at men to suppress their testosterone levels any more. But men with prostate cancer will know of drugs such as Zoladex that aim to reduce their testosterone. In fact, and I quote from the American Cancer Society, the aim of Hormone Therapy - also called Androgen Deprivation Therapy, or Androgen Suppression Therapy - is "to reduce levels of male hormones called androgens and to stop them fueling prostate cancer cells".  Apart from Zoladex, there are other drugs to cut your testosterone in various ways, including Lupron, Trelstar, Vantus, Abiraterone, Degaralix, Ketoconozole, Flutamide, Bicalutamide, Nilutamide. A side-effect of commonly-used Zoladex is that it increases blood fat levels. We will return to this later.

Peter Boyle of The International Prevention Research institute has reviewed two 'Meta-studies'  and, presenting his findings at the American Urological Association's Annual Symposium, he stated that serum testosterone levels had no links to PSA levels nor to risk of Prostate Cancer. He went on to say that the use of testosterone supplementation - in cases of hypogonadism - also showed no links to increased risk of prostate cancer. He was very clear - there is no link between serum testosterone and prostate cancer. A team from Baylor College, Harvard Medical School and others went further. In their meta-analysis in 2015; they showed that high testosterone was neither a risk factor for prostate cancer, nor did it increase progression. Moreover they talked about how low testosterone was linked in some studies to risk and progression and even advocated looking into Testosterone Therapy!!

Go to: No link between testosterone and prostate cancer

A 2016 study(5) followed men who had prostate cancer and were on Active Surveillance (’Watch and Wait’) and showed that those given more testosterone across a three year period resulted in no increase in prostate cancer growth or aggression.

Oestrogen and prostate cancer risk

Put simply, testosterone in men makes us lean and mean. Around the age of 50 our testosterone levels start to decline and we increase our fat stores. At the same time levels of oestrogen (estrogen) start to rise.

In women, for example, oestradiol is known to be made by aromatase enzymes in their fat stores and is strongly linked to breast cancer. Estrogen-positive breast cancer patients are given aromatase inhibitor drugs to stop this and cut their estrogen levels. 

Back in 2005/6, we presented research that showed men had a higher risk of an enlarged prostate if their oestrogen (estrogen) levels increased. Other factors - like saturated fat and dairy consumption have a straight line direct link to prostate cancer, according to research from the Kaolinska Institute in Sweden. We even covered research about too much saturated fat consumption in your teenage, formative, years might be linked to prostate cancer later in life. Conversely, taking a daily fish oil supplement seems to be protective.

Go to: Prostate cancer - What's the cause?

We have also looked at studies from Australia, Singapore, Japan and MD Anderson in Texas, which all pointed in one direction: Namely that as a man ages, his oestrogen levels increase, while his testosterone levels decline. And this leads to an era of higher prostate cancer risk.

And research shows you need both hormones present for prostate cancer. Why? Because oestrogen turns nice, safe testosterone into DHT, DiHydroTestosterone, which is the aggressor that causes prostate cancer.

When, back in 2006 we asked a UK prostate cancer expert about this, he said it was an ‘interesting theory, but we’ve found that oestrogen is very successful in treating prostate cancer so it can’t be right’. However, the ‘theory’ came from top Professor in prostate oncology Dr. Timothy Thompson at MD Anderson. And also, in the days when our London head of prostate cancer used oestrogen to cut testosterone levels it only gave about three years of respite after which the testosterone levels rose and with all that oestrogen, the cancer became more aggressive! 

However, despite a change in methodology, current orthodox medical treatment for prostate cancer still aims to cut nasty old testosterone. 

High testosterone appears protective in prostate cancer.

There is clear research against the ‘high testosterone is dangerous’ argument. 

   * Firstly, we know that the higher your testosterone levels the lower your risk of death from all health causes: In a study of 3,942 men, the risk of death by any cause was decreased in men with higher testosterone and growth hormone (IGF-1) levels. High testosterone promotes health, survival and longevity(1).  

   * Testosterone has an affect on brain function and low testosterone significantly increases your risk of Alzheimer’s disease

   * Then there's the Boyle studies above . More than 30 studies and showed that men with the highest levels of testosterone had no greater risk of prostate cancer than those with the lowest levels. And in 24 randomised, placebo controlled studies involving hormone replacement therapy (using Testosterone), Testosterone supplementation neither increased PSA levels significantly, nor caused more cases of prostate cancer. 

   * Worse, testosterone levels are declining in men in the Western world, especially in men over 50 years of age, while levels of oestrogen are increasing. And this is the highest risk group for prostate cancer.

    * Finally, in body builders who take testosterone supplements there is less prostate cancer, not more.

Testosterone levels in men are declining

In 2002, Travison et al. showed show a massive decline in 1,532 Massachusetts’s men’s testosterone levels over the past 20 years, but these were not related to ‘normal’ aging or other health and lifestyle factors that would normally affect testosterone levels. Several studies have confirmed this finding since. Higher levels of fat, stress and xenoestrogens seem the cause.

We also know that lifestyle issues like higher body fat levels in men are linked with higher levels of oestrogen, and that overweight men develop more prostate cancer.

But we also know that environmental chemical pollution can decrease testosterone levels. Common chemicals (called xenoestrogens) that once in the body can mimic the action of oestrogen reduce testosterone levels and sperm count - 

      *  for example phthalates (2) 

      *  for example, lead (3) ; 

      *  for example, BPA  (There's a study of Chinese factory workers led by Dr. De-Kun Li, at Kaiser Permanente, California). 

And we covered research in Cancer Watch  that prostate cancer has also been linked to 13 such xenoestrogens.

When males are young, their testosterone keeps them fit and lean. As their testosterone declines they become fatter, and more likely to have make more oestradiol.  Obesity and high blood fats are linked to prostate risk. Dietary saturated fat consumption is linked to higher prostate cancer risk. And a high fat diet has been linked to more metastases and lowered prostate cancer survival. 

Go to: Higher saturated fat consumption and blood fats linked to more matastases and lowered survival

And, it is not just about your fat stores around your tummy and hips, it is about the levels of cholesterol and triglycerides in your blood.

Now, remember what we said above about Zolodex putting up your blood fats? 

Go to: Zolodax increases blood cholesterol and triglyceride levels

Fortunately there is research on atorvastatin increasing prostate cancer survival times, and other studies showing that the tomato-extract Lycopene reduces prostate cancer risk, and aggressive prostate cancer and fatal prostate cancer. Lycopene cuts blood fats, is an antioxidant, blocks prostate cancer using glutamate as a fuel and even kills a few cancer stem cells.

What's glutamate got to do with prostate cancer

Glutamine is a non-essential amino acid. It is largely found in animal protein and so, theoretically, consuming large quantities og glutamine might put up your blood levels. If cancer cells cannot obtain glucose, they can turn to glutamine which is converted into glutamate - a fuel for cancer. Prostate cancer seems more likely to thrive on glutamate than other cancers.

In prostate cancer, researchers found that there is a direct link between blood glutamate levels, the Gleason Score, and the aggression of the prostate cancer. I quote - "Glutamate deprivation or blockade with pharmacological inhibitors of glutamate release or metabotropic glutamate receptor 1 (GRM1) decreased growth, migration and invasion and induced apoptosis". 

Alternatively we have research that Ursolic Acid (Holy basil, pistachio nuts), lycopene, turmeric, resveratrol and pomegranate also stop prostate cells feeding on glutamate.

Clinical trials - giving testosterone to men with prostate cancer

But, back to testosterone! It’s time to talk about the work of Professor Samuel R. Denmeade, an expert in oncology and urology at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center.

His team is actually studying whether giving men testosterone will improve progression-free survival times over the drug enzalutamide (Xtandi) in men with advance prostate cancer, who have already had abiraterone. 

What makes this interesting is that the trial will give testosterone to prostate cancer patients whose cancer has progressed as castration-resistent. And Xtandi was developed for men whose prostate cancer progressed and spread DESPITE them having surgery or drugs to cut their testosterone!   

In other words, this research is going to do the opposite of conventional theory.   

The theory is called ’Bipolar Cycling’ or ’Bipolar Androgen Treatment’ (BAT) where patients experience alternate low and high levels of testosterone.

This is a part of an ongoing phase II trial, the RESTORE Trial(6) - RE-sensitising with Supraphysiologic Testosterone to Overcome Resistance. The men in the RESTORE trial are all on Zoladex or similar.

Early days yet but definitely positive signs in the RESTORE Trial - for example PSA fell in 40% of men; and by 50% in 30% of the trial group.  

Could the answer lie with anti-oestrogen drugs instead

Are you still convinced ‘high testosterone is dangerous’? No increased risk; no increase in progression; low testosterone may be linked to increased risk. And what of the need to have oestradiol converting nice, safe testosterone into DHT, which is a potent threat?

So let's revisit the drug Dutasteride, also called Avodart. One randomised, double blind, placebo-controlled study published in the New England Journal of Medicine, involved 6729 men with a PSA of 2.5 to 10.0, and one negative prostate biopsy were followed for 4 years. Those in the Dutasteride group had a 22.8% lowered risk of developing prostate cancer. In a meta-analysis involving men with BHP, the level of prostate cancer was reduced by almost 50% in the Dutasteride group over the placebo group.

Then we come to Charles E. Myers (Snuffy), one of America's top scientists. He developed 6 top drugs and then developed prostate cancer. This he beat using old 'off-label drugs. He treated two of my patients (both with bone metastases) and one of the drugs he regularly uses is Avodart. He believes the involvement of this drug contributes significantly to long-term survival in men with prostate cancer. See here - Path to durable remission in prostate cancer 

There is a warning from the FDA on both Dutasteride, Avodart and Finasteride, Proscar or Propecia, that they can increase the risk of prostate cancer and erectile dysfunction.

The bottom line

Chris Woollams, a founder of CANCERactive and a former Oxford University Biochemist said, "It all really seems a bit of a mess. Low Testosterone makes matters worse and standard treatment is to cut testosterone! Blood fat levels make matters worse, and standard treatment raises them! Anti-oestrogens seem to do a good job - our own Professor Robert Thomas put broccoli in POMI-T and it cuts PSA and pushes back the need for surgery by years, and no oncologist thinks to use an anti-oestrogen, or indole 3 carbinol, or melatonin?. Meanwhile the number of deaths climb, and recurrence is a major factor. As a friend of mine with a prostate cancer a decade ago said 'there doesn't seem to be best practice in prostate cancer',

He could well be right."

Go to: Overview of Prostate cancer: symptoms, causes and treatment alternatives 

* * * * * * * * 
References
1. Steroids. 2012 Jan;77(1-2):52-8. doi:10.1016/j.steroids.2011.10.005. Epub 2011 Oct 20. Friedrich N, Schneider HJ, Haring R, Nauck M, Völzke H, Kroemer HK, Dörr M, Klotsche J, Jung-Sievers C, Pittrow D, Lehnert H, März W, Pieper L, Wittchen HU, Wallaschofski H, Stalla GK. Institute of Clinical Chemistry and Laboratory Medicine, Ernst Moritz Arndt University, Greifswald, Germany.

2. Toxicological Sciences, 2008, 105(1):153-165; 

3.  Infertility, 1978, 1(1):33-51

4. /cancer-active-page-link.aspx?n=3392&title=Orthodox-treatment-a-waste-of-time-in-men-over-55-diagnosed-with-prostate-cancer

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736350/

 

6. https://clinicaltrials.gov/ct2/show/NCT02090114

 

2013 Research
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