#310 - The relationship between testosterone and prostate cancer, testosterone replacement therapy, and tools for predicting cancer aggressiveness and guiding therapy | Ted Schaeffer, M.D., Ph.D.

The Peter Attia Drive

Peter Attia, MD

Health & Fitness, Medicine, Fitness

4.7 • 7.3K Ratings

🗓️ 22 July 2024

⏱️ 48 minutes

🔗️ Recording | iTunes | RSS

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Summary

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Ted Schaeffer is an internationally recognized urologist specializing in prostate cancer and a returning guest on The Drive. In this episode, Ted provides insights into the role testosterone plays, or doesn't play, in the initiation and progression of prostate cancer. He unpacks the findings and limitations of the recent TRAVERSE trial, exploring the complex relationship between testosterone and prostate cancer. Ted delves into the molecular nature of prostate cancer, explaining the androgen receptor saturation theory and the potential impact of testosterone on cancer growth. He also discusses the use of the Decipher test to predict cancer aggressiveness and guide targeted treatment. Furthermore, Ted shares how he counsels patients regarding testosterone replacement therapy (TRT), including its safe administration in patients with low-grade prostate cancer. Additionally, he highlights advancements in prostate cancer therapies and biomarkers that help develop precise treatment strategies while minimizing the need for broad androgen deprivation therapy.

We discuss:

Background on the TRAVERSE trial: insights into exogenous testosterone and prostate cancer risk [3:00];
The androgen receptor saturation theory: how different organs respond to varying levels of testosterone [10:30];
The relationship between testosterone levels and prostate cancer aggressiveness: how aggressive prostate tumors have lower androgen receptor activity and rely on different growth mechanisms [16:15];
Using the Decipher score to assess prostate cancer aggressiveness and guide personalized treatment strategies [23:45];
Considerations for testosterone replacement therapy: how Ted counsels patients, how TRT can be safely administered in patients with low-grade prostate cancer, and more [31:15];
Advancements in prostate cancer therapies and PSA as a biomarker for precise treatment decisions, minimizing the need for broad androgen deprivation therapy [38:30]; and
More.

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Transcript

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0:00.0	Hey everyone. Welcome to the Drive Podcast. I'm your host, Peter Attia. This
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1:02.0	My guess this week is Dr. Ted Schaefer.
1:06.4	Ted was a guest previously on episode 273 in October of 2023 and
1:11.5	episode 39 all the way back in February of 2019. I wanted to have
1:15.6	Ted back on to speak about one very specific topic, testosterone and prostate cancer,
1:21.4	given a recent study that came out since our last
1:23.4	conversation. Given the interest in this topic that we see in our practice in
1:27.7	addition to all of the questions that are constantly coming at us through our
1:31.3	site and social media.
1:32.7	I figured it would be great to have Ted back on to speak about this.
1:36.5	Throughout this podcast, we reference the Traverse Trial,
	...

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