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Atualmente, o cancro da próstata constitui uma das neoplasias malignas mais frequentes e a quinta causa de morte no sexo masculino. A sua incidência tem vindo a aumentar devido ao seu diagnóstico cada vez mais precoce e aprimoramento das técnicas e métodos de diagnóstico e tratamento. É na área do tratamento que este trabalho se enquadra, nomeadamente no que diz respeito ao papel da testosterona. Desde que Huggins e Hodges demonstraram, em 1941, que a carga de doença do cancro da próstata metastizado aumentou através de injeção andrógena e diminuiu através castração cirúrgica ou injeção estrogénica, existem muitas preocupações relativamente ao uso de terapia com testosterona em homens com história de cancro da próstata ou com cancro da próstata ativo, existindo mesmo a ideia que dar testosterona a um homem com cancro da próstata seria como “deitar mais lenha na fogueira”. No entanto, este paradigma tem vindo a mudar. O que conceptualmente era uma contraindicação absoluta, é, hoje em dia, suportado por um conjunto de estudos e evidências que validam o uso de testosterona no cancro da próstata, quer ativo quer pós tratamento potencialmente curativo. No sentido de explorar a evidência atual acerca deste tema fiz esta revisão, onde foi resumida e analisada a mais variada literatura, nomeadamente artigos originais no banco de dados PubMed nos últimos 10 anos e ainda guidelines da Associação Europeia de Urologia (EAU) e Sociedade Europeia de Endocrinologia (ESE) referentes à utilização da testosterona em homens pós tratamento potencialmente curativo para cancro da próstata, nomeadamente prostatectomia radical, braquiterapia ou radioterapia externa ou outras modalidades de tratamento, como crioterapia e HIFU, assim como homens com cancro da próstata ativo, nomeadamente em vigilância ativa e ainda sob terapia com testosterona contínua e terapia bipolar androgénica, uma nova e promissora aplicação de testosterona no cancro da próstata. As evidências não são grandes o suficiente para concluir com grande certeza a segurança da terapia com testosterona nesta situação. No entanto, os estudos atuais permitem concluir que a mesma pode ser aplicada com segurança em homens com hipogonadismo e com cancro da próstata tratado, especialmente se doença de baixo risco ou mesmo aqueles que estão em vigilância ativa, e que a mesma não causa necessariamente um crescimento rápido e universal do tumor na maioria dos homens com cancro da próstata.
Currently, prostate cancer is one of the most frequent malignancies and the fifth leading cause of death in males. Its incidence has been expanding due to its increasingly early diagnosis and improvement in techniques and methods of diagnosis and treatment. It is in the area of treatment that this work fits, particularly in regard to the role of testosterone. Since Huggins and Hodges demonstrated in 1941 that the burden of metastatic prostate cancer disease has increased through androgenic injection and decreased through surgical castration or estrogenic injection, there are many concerns regarding the use of testosterone therapy in men with a history of prostate cancer or with active prostate cancer, there is even the idea that giving testosterone to a man with prostate cancer would be like "throwing more fuel into the fire." However, this paradigm has been changing. What was conceptually an absolute contraindication, is nowadays supported by a set of studies and evidences that validate the use of testosterone in prostate cancer, either active or potentially curative post-treatment. In order to explore the current evidence on this topic, I reviewed this paper as well as summarized and analyzed the most varied literature, including original articles in the PubMed database in the last 10 years, as well as guidelines of the European Association of Urology (EAU) and the European Society Endocrinology (ESE) concerning the use of testosterone in men after potentially curative treatment for prostate cancer, namely radical prostatectomy, brachytherapy or external radiotherapy or other treatment modalities, such as cryotherapy and HIFU, as well as men with active prostate cancer, specifically in active surveillance and still under continuous testosterone therapy and androgenic bipolar therapy, a new and promising application of testosterone in prostate cancer. Evidence is not large enough to conclude with great certainty the safety of testosterone therapy in this situation. However, current studies allow the conclusion that it can be safely applied in men with hypogonadism and treated prostate cancer, especially if low-risk disease or even those under active surveillance, and that it does not necessarily cause rapid and universal tumor growth in the majority of men with prostate cancer.
Currently, prostate cancer is one of the most frequent malignancies and the fifth leading cause of death in males. Its incidence has been expanding due to its increasingly early diagnosis and improvement in techniques and methods of diagnosis and treatment. It is in the area of treatment that this work fits, particularly in regard to the role of testosterone. Since Huggins and Hodges demonstrated in 1941 that the burden of metastatic prostate cancer disease has increased through androgenic injection and decreased through surgical castration or estrogenic injection, there are many concerns regarding the use of testosterone therapy in men with a history of prostate cancer or with active prostate cancer, there is even the idea that giving testosterone to a man with prostate cancer would be like "throwing more fuel into the fire." However, this paradigm has been changing. What was conceptually an absolute contraindication, is nowadays supported by a set of studies and evidences that validate the use of testosterone in prostate cancer, either active or potentially curative post-treatment. In order to explore the current evidence on this topic, I reviewed this paper as well as summarized and analyzed the most varied literature, including original articles in the PubMed database in the last 10 years, as well as guidelines of the European Association of Urology (EAU) and the European Society Endocrinology (ESE) concerning the use of testosterone in men after potentially curative treatment for prostate cancer, namely radical prostatectomy, brachytherapy or external radiotherapy or other treatment modalities, such as cryotherapy and HIFU, as well as men with active prostate cancer, specifically in active surveillance and still under continuous testosterone therapy and androgenic bipolar therapy, a new and promising application of testosterone in prostate cancer. Evidence is not large enough to conclude with great certainty the safety of testosterone therapy in this situation. However, current studies allow the conclusion that it can be safely applied in men with hypogonadism and treated prostate cancer, especially if low-risk disease or even those under active surveillance, and that it does not necessarily cause rapid and universal tumor growth in the majority of men with prostate cancer.
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Keywords
Bat Cancro da Próstata Hipogonadismo Testosterona Trt