Mohit Khera, MD, MBA, MPH, presented “Testosterone to Improve the Diagnosis and Treatment of Prostate Cancer” at the 27th Annual Innovations in Urologic Practice conference on September 22nd, 2023.
How to cite: Khera, Mohit. “Testosterone to Improve the Diagnosis and Treatment of Prostate Cancer?” September 2023. Accessed Nov 2024. https://grandroundsinurology.com/testosterone-to-improve-the-diagnosis-and-treatment-of-prostate-cancer/
Testosterone to Improve the Diagnosis and Treatment of Prostate Cancer – Summary
Mohit Khera, MD, MBA, MPH, explores how testosterone can help diagnose and treat prostate cancer. He explains that low testosterone is a biomarker for prostate cancer, a predictor of who will progress on active surveillance (AS), and a risk factor for biochemical recurrence after prostatectomy. Further, testosterone therapy can be a treatment for metastatic prostate cancer.
Dr. Khera argues that while testosterone should not be considered a monotherapy, it can augment treatment. He explains PSA has poor sensitivity and addresses biomarker tests that seek to improve sensitivity and specificity. Dr. Khera asserts the ratio of testosterone to PSA has sensitivity of 82 percent and specificity of 62 percent, with lower costs than biomarker tests. He cites data explaining for men with low testosterone, PSA alone may not be accurate. Dr. Khera cites another study on testosterone as a predictor of upstaging and upgrading in low-risk AS patients. It concludes testosterone should be a selection criterion for inclusion of low-risk prostate cancer patients in AS programs.
Dr. Khera explains lower preoperative testosterone levels increase the risk for prostate cancer recurrence. Dr. Khera turns to treatment options, looking at bipolar androgen therapy (BAT) that includes patients with advanced disease receiving high doses of testosterone which results in a 50 percent reduction in both PSA and metastatic disease. Dr. Khera cites a study on BAT for asymptomatic men with castration-resistant prostate cancer; the BAT was well-tolerated and resulted in high response rates.
Dr. Khera cites the TRANSFORMER study comparing BAT vs. enzalutamide. Data show no difference in survival; however, patients who switched from BAT to enzalutamide had the highest survival rates. Dr. Khera concludes that testosterone can improve prostate cancer diagnosis and counseling for patients on biochemical recurrence; it comes with significantly less cost and offers greater quality of life.
About The 27th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma; men’s health topics like male infertility, andrology, and sexual dysfunction; OAB and voiding dysfunctions; and ways to diagnose and treat infections in the urology patient.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Mohit Khera, MD, MBA, MPH, is a board-certified urologist specializing in male infertility, male and female sexual dysfunction, and declining testosterone levels in aging men. Dr. Khera’s research focuses on the efficacy of botulinum toxin type A in treating Peyronie’s disease as well as genetic and epigenetic studies on post-finasteride syndrome patients and testosterone-replacement therapy.
Dr. Khera earned his MBA and MPH from Boston University before earning his MD from the University of Texas Medical School at San Antonio. Dr. Khera completed his urology residency training in the Scott Department of Urology at Baylor College of Medicine (BCM) where he also completed a one-year general surgery internship. After completing his urology residency, he went on to complete a one-year fellowship in Male Reproductive Medicine and Surgery at BCM. Currently Dr. Khera is a professor in the Scott Department of Urology at Baylor College of Medicine, and he holds the F. Brantley Scott Chair in urology. Dr. Khera also serves as the director of the Laboratory for Andrology Research, the medical director of the Baylor Executive Health Program and the medical director of the Scott Department of Urology. He also serves as president of the Sexual Medicine Society of North America.
Dr. Khera has initiated numerous FDA-approved clinical trials. His scientific and clinical experiences have allowed him to thus far give over 400 lectures at scientific meetings throughout the world, publish over 160 articles in peer-reviewed journals, complete 15 book chapters, and edit and write two books in the field of sexual medicine and men’s health. Dr. Khera shares his time and knowledge with the general public. He has been voted several times as one of Houston’s Best Doctors by Health and Sport Fitness Magazine and by Houstonia Magazine and is a frequent guest on such TV programs as Fox News’ “Ask theDoctor.” He also writes a blog on men’s health for the Houston Chronicle newspaper.
