Do Steroids Cause Prostate Cancer?

This is a very common question among bodybuilders thinking of doing steroids. It  also is a concern for middle aged men thinking of trying testosterone supplementation. You may have read about some links between prostate cancer and steroids/HRT therapy. Is it really fact or is it just based on far reaching assumptions?

Steroids and prostate growth (BPH)
Before we discuss anabolic steroids and it’s role on prostate cancer, first we must discuss steroids’ possible actions on prostate growth (BPH). The prostate first grows during puberty. Then around 25, the prostate starts to grow again in a 2nd phase. The 2nd phase eventually may lead to prostate enlargement years down the road. Half the men in their 60′s will have significant prostate enlargement.
Steroids(including normal testosterone in the body) stimulate the androgen receptors in the prostate. Excessive levels of androgenic steroids (such as through steroid use) causes prostate growth/enlargement called BPH (Benign prostate hyperplasia) in a short period of time. Once excessive system levels of androgenic steroids drops, than the prostate will start to shrink back again. It may not shrink completely back to it’s former size however.
In non-steroid users, testosterone mainly causes it once it converts to DHT. DHT is much more androgenic(binds to the receptors stronger) than testosterone. The drug finasteride is prescribed to help alleviate prostate growth. It works by blocking the conversion of testosterone to DHT. Steroid users will often use finasteride, in order to block the effects of hair loss and prostate growth while on cycle.

BPH caused by Testosterone or Estrogen?
In non-steroid users, older men are afflicted with BPH. This seems backwards, since BPH is supposed to be correlated with high androgens right? We know that older men have lower testosterone(and DHT) levels, so how is this possible?
Well there is 3 basic theories on what causes BPH for non-steroid users. No one yet seems to know for certain which theory is correct.
Theory 1 - Excessive estrogen levels. Older men have a higher estrogen and lower testosterone levels. According to research, the use of anti-estrogens are well documented to help shrink the prostate. The famous steroid research chemist Patrick Arnold, has claimed that there is more evidence pointing to a high estrogen to low testosterone being the cause of BPH.
Theory 2 - Despite the lowering testosterone levels( and hence DHT) levels in older men, research suggests men still probably accumulate high levels of DHT in the prostate. This would explain why people why older men can still get BPH despite declining levels of testosterone and DHT in the body. Another fact to help support this theory, is that Men who don’t produce DHT naturally due to genetic defect, also don’t develop BPH.
Theory 3 – Genetic Programmed growth. The fact that prostate cells awaken again in the mid 20′s to re-grow suggests that maybe BPH growth is programmed genetically. By the time men are in their 90′s, 90% will suffer from BPH.
Other interesting study results: In one study, when estrogen and dht were both reduced with hormonal blockers, the prostate gland actually increased in size. This is startling since if one of these hormones is to play a role in BPH, why when reducing both, did it cause prostate growth?

What causes prostate cancer?
First we must realize BPH and prostate cancer are not the same thing. BPH is a condition of excessive growth of the prostate. They do not know currently, if BPH is a pre-cursor condition to prostate cancer. Prostate cancer is actually a very common occurence in men, much more than the public is aware. It is said that most men would die of prostate cancer, if they didn’t die of something before that. Prostate cancer is usually very slow growing. Many elderly men live decades with prostate cancer and may not even know they have it.
The truth is, no one really knows what leads exactly to prostate cancer. There is a lot of conflicting data. In fact, if you look at many studies out there, most don’t even show a link between prostate cancer and higher testosterone levels. Yet, many doctors seem to believe it does. Some recent studies have shown that there was no increased risk of prostate cancer based on testosterone levels. Many doctors who put middle aged men on testosterone replacement therapy, have not seen a higher incidence of prostate cancer developing. Doctors are also usually worried about BPH from testosterone, but men have actually had a reduction in their BPH from using testosterone hormone replacement therapy to treat low testosterone.
The fear of prostate cancer by doctors, is one reason why doctors are often hesitant to do HRT(hormone replacement therapy). HRT therapy is for older men and others deficient in testosterone, to bring them up to healthy levels. The January 2004 New England Journal of Medicine (NEJM) wrote that testosterone does not cause prostate cancer, but they need to be monitored, since it may stimulate hidden prostate cancer. What do they mean by hidden prostate cancers? Apparently in about half the men over age 50, they may have prostate cancer, but it is asymptomatic. In other words, it is not growing and causing harm. If they were to supplement with testosterone, according to them, it may possibly stimulate these harbored cancer cells into a aggressive form of prostate cancer. That is why doctors will check for PSA(prostae specific antigen), BPH, and have more frequent prostate exams when starting HRT therapy. PSA is a very accurate marker of existing cancer and when it goes back to zero it means the person has been cured. Testosterone therapy could “awaken” these sleeper cancer cells. This is what they theorize, yet there is no scientific research to show that this is really what happens.
What we do know, is that there is many factors that might increase the risk of prostate cancer.
1) Increased ejaculation in your 20′s. This may sound awkward, but there were some studies that recently came out with this result. They found that those who ejaculated a lot more frequently in their 20′s, had less likely occurence of prostate cancer. The prostate gland is known to hold a much higher concentration of the bodies’ toxins. The researchers believed that ejaculation may lead to “cleansing” the prostate from carcinogens (cancer causing toxins).
2) Genetics & Heredity – Prostate cancer also seems to run at a higher rate in families with a pre-disposition to it. There is currently research looking at various enzymes and prostate genes, that may be involved in developing the cancer. African americans also have a higher incidence of prostate cancer.
3) Diet/Environment – Diets high in animal fat increase incidence of prostate cancer. Men who moved from Japan where prostate cancer incidence is lower, had increased risk in their sons and grandsons when living in the U.S. Therefore, diet and other environmental factors seem to increase risk of prostate cancer.

Summary
Prostate cancer is caused by a variety of risk factors. Experts seem to continue to try and make this link between high testosterone levels (or other steroids) and prostate cancer, yet there is no real solid research proof that testosterone levels is the direct cause. There is a growing body of research showing there is no link and that it may be caused by other factors. If Testosterone and steroids caused prostate cancer, a lot of men at a young age would probably be getting prostate cancer.

Can Testosterone Replacement Therapy Cause Cancer?

One of the pressing questions men ask when faced with the possibility of starting testosterone hormone therapy is, “Can testosterone replacement therapy cause cancer?” Up until recently, this question would likely have been answered by most doctors with a resounding “yes.”

However, a great deal of research has been done to determine whether the “yes” response to the question about testosterone therapy and prostate cancer is accurate, and based on accumulating evidence, it appears the answer is “no.” One compelling reason for the “no” response can be attributed to the comprehensive investigative work done by Abraham Morganthaler, MD, FACS, author of Testosterone for Life, who evaluated the original work by urologist Charles Higgins in the 1940s, research that led to the misconception that taking testosterone can cause prostate cancer.

Morganthaler discovered that this idea arose out of one case study involving one patient. In other words, the fear that testosterone therapy can cause prostate cancer was based on nothing. In fact, in recent years there have been many studies that dispel the myth that testosterone replacement therapy causes prostate cancer or has a significant negative impact on the prostate. For example:

    A Beth Israel Deaconess Medical Center review of 72 studies (Rhoden 2004) found “no compelling evidence that testosterone replacement therapy increases the incidence of prostate cancer.”
    A report by The Prostate Cancer Center Hamburg-Eppendorf in Germany. (Isbarn 2009) stated “the available research strongly suggested that testosterone therapy neither increases the risk of prostate cancer in normal men nor causes a recurrence of the cancer in men who have been treated successfully for prostate cancer.”
    In a study of 57 men who received testosterone supplementation for an average of 36 months after prostatectomy surgery, although mean testosterone levels rose in all the men before testosterone therapy, there was no increase in PSA values after testosterone therapy started. So, testosterone replacement therapy caused hormone levels to rise, PSA values to remain the same, and symptoms to be relieved. Baylor College of Medicine study (Khera 2009)
    A study conducted within the ongoing Osteoporotic Fractures in Men cohort looked at the association between testosterone, estradiol, estrone, and sex hormone-binding globulin and prostate cancer. Only estrone was strongly related to an increased risk of prostate cancer. University of California, San Francisco.
    In a landmark study reported in 2006, men who had low testosterone levels were given testosterone injections or placebo every two weeks for six months. Before and throughout the study, the investigators took measurements of testosterone and DHT from both blood samples and the prostate itself. The researchers found that although blood concentrations of testosterone and DHT rose substantially in men who were given hormone replacement therapy, the concentration of testosterone and DHT did not change at all in the prostate gland. In addition, testosterone therapy had no effect on biochemical markers of prostate cell growth. Therefore, the authors noted that while testosterone replacement therapy normalized blood levels of testosterone, treatment did not affect prostate tissue or prostate cell functions. According to Morganthaler, “it is as if once the prostate has been exposed to enough testosterone, any additional testosterone is treated as excess and does not accumulate in the prostate.” To state it another way, he said “we say the prostate has been saturated with regard to testosterone.”

According to a Johns Hopkins Prostate Disorders Special Report, “Testosterone-Replacement Therapy: Does It Increase Prostate Cancer Risk?” the jury is still out on whether testosterone replacement therapy is safe when men take it for a prolonged time. Morganthaler would take that a step further, as he has noted that “The relationship of testosterone to prostate cancer has undergone a significant reevaluation, and all recent evidence has reinforced the position that testosterone therapy is safe for the prostate.”

In addition, if you already have prostate cancer, the concern has been that taking testosterone could make the cancer progress faster, or that the hormone could promote tumor growth. These worries are the reasons why some doctors will not prescribe testosterone therapy for men who have a history of prostate cancer.

Obesity Complicates The Detection Of Prostate Cancer!

According to a new study in the presence of overweight or obese patient standard methods of screening for prostate cancer may not detect dangerous pathology. This is the risk that the doctor simply overlooking, the cancer early, dooming the patient's suffering.

For the 2001 - 2004 years, scientists from the University of Texas Health Science Center, San Antonio studied 2,779 men without prostate cancer. As it turned out than obese men, the lower the content of his blood prostate-specific antigen (PSA), a reliable marker for prostate cancer. Typically, the PSA level less than 4.0 units, and this means that there is no cancer.

Further worsens the situation is the fact that prostate cancer in men occurs more thick malignant. It is quite possible that this is due to increased malignancy is more recent discovery of the tumor. PSA for prostate cancer in obese patients with an average of 30% lower. The researchers hope that the study will make doctors more closely examine obese patients for prostate cancer, especially with regard to the interpretation of PSA testing in the blood. Thus, obese men sensitivity of detection of PSA in the diagnosis of prostate cancer is reduced. So, the doctor should never rely solely on technology, one can not "overlook" this pathology.

Antigen concentration in the blood is determined in the analysis produced by normal prostate cells. The higher the PSA, the more likely that cancer cells divide uncontrollably, and this is the first step to cancer, and he may have actually. The diagnosis of prostate cancer can not be placed solely on the basis of indicators of PSA, as recommended by the American oncologists and urologists need biopsy tissue cancer.

In addition, the issue of cancer, "the President's cancer", so it is called by the people, must take account of these previous studies, that is, even with normal PSA levels in 15% of cases could be cancer, and in 66% of these patients, an aggressive malignant form.

The scientists who conducted the study, do not explain why obese patients with prostate cancer, the PSA level below. Most likely, this is due to the fact that obese men produce more estrogen, which suppresses testosterone and thus affects the cells that produce the antigen.

Five Most Common Cancers In Men

Cancer presents a real danger for men's health. However, suspicions about the existing danger and knowing to recognize its major symptoms, men get the chance to live a longer life.

1. Prostate cancer
Unfortunately, on early stages prostate cancer does not show itself, therefore if during digital rectal examination your doctor found that prostate gland is increased, it is necessary to make blood test to find out the amount of prostate-specific antigen (PSA test) and if necessary to make biopsy.

2. Lung cancer
Its major symptom is persisting long-lasting cough, blood in cough spit, pains in chest that are not connected with movements.

3. Bowel cancer
Blood in feces is the sign that you should go to the doctor. Sometimes its cause may be hemorrhoid and diverticulitis and sometimes it may be precancerous polypus. Anyway it is necessary to perform colonoscopy.

4. Bladder cancer
Early symptom of this cancer may be blood in urine.

5. Lymphadenoma
In case lymph glands are increased on the neck, arm-pits, groin and if nodes do not go away during a week it is necessary to seek doctor's advice. Another cause to worry is sudden weight loss or pains in  lymph glands after drinking alcohol.

Signs and Symptoms of Prostate Cancer

In most cases prostate cancer at first stages courses without symptoms. Complaints appear when growth spreads to other organs and metastasis do appear. Prostate cancer progresses relatively slow and thus at the beginning shows with very few symptoms. In several years symptoms grow.

When cancer courses without symptoms the only way to detect it is PSA test which examines rate of prostate specific antigen in male blood. In this case growth size is not significant or are found only pre-cancerous changes.  When growth increases and spreads to urinary tract and bladder, may appear urinary irritation symptoms, such as:

-  frequent urination
-  difficulties with urination
-  incontinence of urine
-  sudden micturate urge

Also patient may suffer from symptoms of upper urinary tract blocking:

-  widening of ureters and kidneys cavity
-  pains in lumbar region
-  calculi formation in kidneys

Metastasis in bones cause pains in limbs, but metastasis in spinal cord lead to paresthesia and paralysis.  Metastasis in organs cause dysfunctions in them.
Thus, all symptoms of prostate cancer are non-specific, they show dysfunctions of damaged organs. That is why to diagnose prostate cancer men over 50 and those predisposed to cancer must make prostate cancer screening.

What Causes Prostate Cancer?

Up to present, scientists have not found yet causes of prostate cancer. They do study intensively the molecular mechanisms of development and progression of this disease. There was found a gene responsible for family cancer cases, or, in other words, particular genetic predisposition for prostate cancer. There were proved theories that in human genome do exist several areas responsible for inhibition of prostate cancer development and their change results in appearing of this disease.

Some growth factors and biologically active substances have an impact on the disease development including formation of metastasis.

Precancerous changes come before prostate cancer. It is considered they may occur as a result of lasting inflammatory processes having corresponding genetic predisposition.

Risk factors for prostate cancer development:
1) Age is major risk factor. The more older male is, more higher risk factor of cancer development is.
2) Race. Males of black race get diseased with prostate cancer more often than others. The disease in them is found at late stages.
3) Heredity. Relatives of people diseased with prostate cancer in younger age have more chances to get this disease.
4) Food. Cancer occurs more often in men who consume a lot of fats.
5) Smoking and unhealthy work. Cadmium which was found in tobacco smoke and also in accumulators and welding materials contribute to cancer development.

It was considered before that vasectomy (male sterilization operation) prevents from prostate cancer development, however, this was not confirmed.

Detection of prostate cancer causes aggravates the fact that in about 30% of cases prostate cancer is not showing itself and is just accidental finding in dissection of people died from other causes.

Prostate Cancer

 Prostate cancer is a cancerous growth that more frequently occurs in middle-aged males. Last years the number of prostate cancer cases is increased. This disease is one of most common among oncological diseases . 25% of new cancer cases in men is prostate cancer.  Despite development of new diagnosis methods and effective treatments, many men go to see the doctor just when the disease gives metastases.

At early stages prostate cancer may course without symptoms. The disease shows itself when tumor is spread beyond prostate gland and gives metastasis. Patient suffers from:
- pains in rump, crotch, scrotum, penis head
- difficult urination
- blood in urine
Difficult urination is associated with spread of tumor into urethra which leads to its narrowing. Blood in urine occurs when tumor presses veins of neck of urinary bladder. If the disease gave metastasis (as a rule, in the bones) then in spots of affection do appear pains of various intensity.
There exist many factors that help to developing prostate cancer:
hormonal disorders
heredity
age
food
geography
environment
bad habots (alcohol, smoking)

As you know, prostate cancer is a hormonal disease. Although the role of hormones is not studied yet, it is known that increased number of androgens may lead to disease development. Heredity plays not last role. It has been proved that there exists genetic predisposition to prostate cancer: if the disease occured in nearest relatives then all males in this family have great chances to disease with prostate cancer.

It is considered that prostate cancer occurs in men over 60 years. However, today is observed tendency for “rejuvenation” of the disease – today cancer is frequently diagnosed in men of 40 – 50 years
Food plays a particular role in prostate cancer development. Males consuming excess amount of fats are most predisposed to the prostate cancer than those who consume less fats and take foods rich with fiber.

Highest mortality from prostate cancer occurs on the north where climate is cold and there is few ultra violet rays providing Vitamin D that helps to prevent from diseae development. Therefore in southern countries prostate cancer occurs rarely than in Russia, Canada, Sweden.

Prostate Cancer: Face To Face With Horrible Diagnosis

If you are diagnosed with prostate cancer you should know how this disease is progressing and you should understand medical terminology. This information should help you to take serious decisions when chosing appropriate methods of treatment.

Course of the disease.

In most cases cancer of the prostate is slow-growing. In fact, aged men do not need treatment because tumor does not influence life time and the disease courses without symptoms.

Condition connected with slight change of shape and size of cells of prostate is called prostatic intraepithelial neoplasia (PIN) and a half of men over 50 years are diagnosed with it. PIN is considered precancerous disease.

Rate of progression prostate cancer: Gleason staging system.

Gleason staging system is used to help to evaluate the prognosis of cancer of the prostate.

• Biopsy. Tissue samples of prostate tumor are taken. Obtained material is going in laboratory for a microscopic examination.


• In laboratory every sample assigns a grade from 1 to 5: one means that sample has only healthy cells and five means the sample has pathological cells.


• The two grades of two most specific tumor samples are added together to get a Gleason score (from 2 to 10). Higher Gleason score means a worse prognosis.

Prostate cancer stages.

Stages do characterize where cancer have spreaded. Doctor needs this information to choose treatment. To define cancer stage the next examinations can be made:

• Digital rectal examination
• Blood tests
• Bone scans
• Computerized tomography
• Magnetic resonance tomography
• Biopsy of prostate and lymphatic glands

There are two systems of describing prostate cancer stages – Whitmore-Jewett staging

and TNM.

Whitmore-Jewett staging system

In this case to describe stage of disease are used letters of A, B, C, D:

A – the tumor has microscopic size and it is not detectable when palpation

B – the tumor or lump are felt (without metastasis)

C – the tumor with metastasis spreaded to the organs located near prostate

D – the tumor with great metastasis spreaded to lymphatic glands and other organs

TNM staging system

Cancer stages can be described also in TNM system. TNM stands for Tumor, Nodes, Metastases.

T – characterises process of primary tumor

T1 – the tumor is not detectable while visual examination and on X-ray picture. Cancer cells are presented in tissue samples taken during prostate hyperplasia operation or during biopsy.

T1a – cancer cells are detected in less than 5% of tissue that was removed. Gleason score is less than 7.

T1b - cancer cells are detected in more than 5% of tissue that was removed. Gleason score is more than 7.

T1c – cancer cells are detected in tissues taken during biopsy (performed due to an elevated serum PSA)

T2 – the tumor can be felt but it does not spread outside capsule covering prostate.

T2a – the tumor is in less than 50% of one part of prostate.

T2b – the tumor is in more than 50% of one part of prostate.

T2c – the tumor is in both parts of prostate.

T3 – the tumor is spreaded on other organs including seminal vescile.

T3a – the tumor is spreaded on other organs but not in seminal vescile.

T3b – the tunor is spereaded on seminal vescile.

T4 – the tumor is spreaded on other organs near prostate, for example, on rectum.

To detect metastasis to other organs it is necessary to make some additional examinations. Prostate cancer often does metastasis to lymphatics glands, bones, lungs and other organs.

To describe metastasis marks of M and N are used.

N – characterises spreading of tumor on lymphatic glands.

Nx – it is not clear if lymphatic glands are invaded or not.

N0 – the tumor is not found in lymphatic glands.

N1 – the tumor is found in one lymphatic gland in small pelvis caverna and it has size of not more than 2 sm.

N2 - the tumor is found in one lymphatic gland in small pelvis caverna. It has size of more than 2 cm but less than 5 cm. The other variant is when the tumor is found in several lymphatic glands in small pelvis caverna but tumors have size of less than 5 cm.

N3 – at least one tumor in lymphatic glands has a size of more than 5 cm.

M – describes spreading of tumor in other organs.

Mx – it is not clear if there is metastasis to other organs.

M0 – metastasis are detected only in prostate and in the nearest lymphatic glands.

M1 – the tumor does metastasis to lymphatic glands beyond small pelvis and\or into other organs (bones, lungs, livers and brain).

Prognosis for prostate cancer.

Almost all cancerous growths of prostate (91%) are detected before they spread beyond prostate. If cancer is diagnosed being at this stage, in 99% of cases patients can live at least 5 years. But the prognosis of survival exacerbates when the tumor did metastasis to other organs.

The second detecting of prostate cancer after a year or more of treatment is called recurrence. Cancer can recur in prostate (even if it was removed) and in other organs including bones. To treat recurescence can be used methods different from those that were used for primary tumor treatment.