A reposição de testosterona pode ser perigosa para pessoas que têm câncer de próstata . Quando usado, deve ser usado com cautela. Pode aumentar o risco de recorrência do câncer de próstata para algumas pessoas que estão em alto risco.
A reposição de testosterona é considerada segura para pessoas com baixo risco de recorrência e que tiveram terapia adequada e são consideradas em remissão.
Teste de sangue de laboratório de testosterona
Os exames de sangue são um fator usado para determinar se a reposição de testosterona é necessária. Se você estiver verificando seu nível de testosterona com um teste caseiro ou em um laboratório, conforme solicitado pelo seu médico, seus resultados podem não ser claros.
Problemas que afetam os níveis sanguíneos de testosterona:
Os níveis sanguíneos de testosterona são mais altos pela manhã e mais baixos à noite.
Um teste feito às 16h que estava “baixo” pode simplesmente estar fora da faixa normal devido à hora do dia em que o sangue foi coletado.
Existem dois tipos de testes de testosterona: testosterona total e testosterona livre.
A maioria dos testes de rotina mede apenas a testosterona total. No entanto, a testosterona livre é uma medida muito mais precisa da atividade fisiológica da testosterona.
Tomar uma decisão sobre sua necessidade de terapia com testosterona não se baseia apenas no nível de testosterona no sangue. É igualmente importante considerar seus sintomas e se eles são indicativos de baixos níveis de testosterona.
Terapia com testosterona e câncer de próstata
A terapia com testosterona pode aumentar o risco de recorrência do câncer de próstata para algumas pessoas.
Alguns fatores que estão particularmente associados a um alto risco de recorrência:
- Extensão extraprostática (disseminação do câncer fora da próstata)
- Margens positivas
- Nós positivos
- Escores de Gleason de 8 ou mais na biópsia
- Invasão das vesículas seminais
Existem algumas situações em que a terapia com testosterona não seria prejudicial e pode ser benéfica para pessoas que tiveram câncer de próstata.
- Homens que têm tumores de baixo grau ou benignos
- Homens que completaram a terapia com cirurgia ou radiação e parecem estar curados podem usar a terapia com testosterona após um período de espera adequado entre dois e cinco anos. O risco de recorrência do câncer neste momento é geralmente bastante baixo.
- Quando um homem com câncer de próstata conhecido tem um baixo nível de testosterona e enfermidade física grave ou perda muscular muito avançada que está associada a uma fraqueza notável.
Por que a confusão?
A confusão sobre o uso da terapia com testosterona em homens com câncer de próstata conhecido surge porque o câncer de próstata não é uma doença única.
Tem:
- Formas de baixo, intermediário e alto grau
- Doença localizada e câncer metastático
- Tipos de sensibilidade hormonal e tipos insensíveis ao tratamento hormonal
Um único protocolo não seria universalmente apropriado para todos os tipos de câncer de próstata.
Administração e riscos da terapia com testosterona
A terapia com testosterona vem em diferentes formulações, incluindo injeções de curta ou longa ação, cremes, géis e adesivos transdérmicos.
Há variabilidade na maneira como os homens responderão à terapia com testosterona. Para algumas pessoas, o impacto da reposição de testosterona é imediato e dramático. Em outros homens, mesmo após um período de teste adequado de seis meses, pode faltar um benefício perceptível.
A única maneira de saber com certeza se você se beneficiará da testosterona é dando-lhe um período de teste adequado.
A reposição de testosterona pode aumentar o risco de coágulos sanguíneos. A terapia de reposição de testosterona a longo prazo está associada a um risco aumentado de problemas cardiovasculares, incluindo ataques cardíacos e derrames, principalmente em homens mais velhos.
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