Warnings still remain on the testosterone supplement product labels regarding the risk of urinary retention and worsening LUTS, and these should be explained to patients. Surprisingly, numerous retrospective or small, randomized trials have pointed to a possible improvement in male lower urinary tract symptoms (LUTS) in patients treated with testosterone. While some studies have suggested no increased risk, others have indicated a potential for increased risk in certain subgroups of men. BPH is the enlargement of the prostate gland, which can cause urinary problems. The primary concern is the overall increase in testosterone levels, regardless of how it’s administered. Therefore, rigorous screening before starting TRT and regular monitoring during treatment are essential to ensure patient safety and to mitigate any potential risks. Radical prostatectomy aims to surgically remove the cancerous part of the prostate, along with the seminal vesicles, and the end of the vas deferens (the duct that delivers sperm from the testes). Brachytherapy is typically performed in a single session, with the radioactive source permanently implanted into the prostate, where it expends its radioactivity within the next few months. This program continues until increases in PSA levels, Gleason grade, or tumor size indicate a higher-risk tumor that may require intervention. Blood PSA levels are monitored every few months to assess the effectiveness of treatments, and whether the disease is recurring or advancing. The EAU also says that TRT may slightly increase prostate volume, but the growth is usually small and doesn’t always cause new symptoms. It does not believe TRT causes BPH, but it does say that testosterone can make mild prostate symptoms more noticeable in some men. The Endocrine Society does not say that TRT directly causes prostate cancer or worsens BPH. They recommend that TRT should only be used in men who have both symptoms of low testosterone and low blood levels confirmed by a lab test. These tests help doctors know if a man’s symptoms are due to BPH, cancer, or another cause. A digital rectal exam (DRE) should also be done every year, or sooner if symptoms change. Men on TRT need regular check-ups to watch for prostate problems. A prostate MRI can give a clear picture of the gland and show any areas that look suspicious. This overlap can make it hard to figure out what is causing the symptoms. When the prostate gets larger, it can press on the urethra and cause problems with urination. It can lead to trouble urinating, getting up often at night to pee, and other bothersome symptoms. Working with both a primary care doctor and a urologist can help make sure that TRT helps the patient feel better without causing new prostate problems. There are small differences in how doctors in the U.S. and Europe may approach TRT. The EAU stresses that BPH and low testosterone often happen together in older men. If a man has both low testosterone and BPH, the urologist may treat both problems at the same time. Several medical groups have published expert recommendations on how and when TRT should be used, especially when the prostate is a concern. Careful screening before and during treatment helps catch problems early. These steps help keep TRT safe, especially for men who have BPH or are worried about prostate issues. Many men on TRT do not report problems with urination, even if their prostate grows slightly. However, the growth is usually minor—about 12% to 30% in volume over time, depending on the dose and form of TRT. It’s important to know that a mild increase in PSA does not always mean cancer. The decision to proceed with TRT should be made on a case-by-case basis, considering individual risk factors and potential benefits. Monitoring PSA levels during TRT helps to detect any potential issues early on. PSA stands for Prostate-Specific Antigen, a protein produced by the prostate gland. These genetically engineered mouse models typically use a Cre recombinase system to disrupt tumor suppressors or activate oncogenes specifically in prostate cells. Several prostate immortalized cell lines are widely used, namely the classic lines DU145, PC-3, and LNCaP, as well as more recent cell lines 22Rv1, LAPC-4, VCaP, and MDA-PCa-2a and −2b. They don’t shrink the prostate, but they make it easier to urinate. This helps improve urine flow and reduce symptoms like a weak stream or the feeling of needing to urinate often. Alpha-blockers relax the muscles in the prostate and bladder. Doctors can use medications and other tools to keep the prostate from growing too much or causing more problems. Years ago, doctors believed that more testosterone always meant a higher risk of prostate growth or even cancer. That’s why it's important to look at the full picture—age, hormone levels, urinary symptoms, and prostate health—before starting or continuing TRT. For example, early studies once suggested that high testosterone could lead to a higher risk of prostate cancer. Elevated PSA levels can indicate prostate problems, including infection, inflammation, benign prostatic hyperplasia (BPH), and prostate cancer. The concern stems from the fact that testosterone can fuel the growth of existing prostate cancer cells. Because testosterone can fuel the growth of prostate cancer cells, it’s crucial to detect and treat any existing cancer before starting TRT. However, it may stimulate the growth of existing prostate cancer cells, so careful screening and monitoring are essential before and during treatment.
