Development of Prostate Cancer in a Patient with Primary Hypogonadism: Intratumoral Steroidogenesis in Prostate Cancer Tissues

October 2012 in “ Andrology ”

Seiji Arai, Yasuhiro Shibata, Yasuhiro Nakamura, Bunzo Kashiwagi, Takatoshi Uei, Yukio Tomaru, Yoshimichi Miyashiro, Sato Honma, Kazuhito Hashimoto, Yoshitaka Sekine, Kazuto Ito, Hironobu Sasano, Kazuhiro Suzuki

testosterone replacement therapy testosterone dihydrotestosterone intratumoural steroidogenesis androgen receptor steroidogenic enzymes androgen metabolism primary hypogonadism TRT T DHT AR

TLDR Prostate cancer can progress even with low testosterone due to internal hormone production in the tumor.

This case report described a 74-year-old man with primary hypogonadism who developed prostate cancer (PC) after testosterone replacement therapy (TRT). Despite low serum testosterone (T) levels, intraprostatic T and dihydrotestosterone (DHT) levels were elevated, suggesting intratumoural steroidogenesis. Immunohistochemical analysis showed positive staining for androgen receptor (AR) and steroidogenic enzymes in malignant prostate tissues. The study highlighted that even with low circulating androgens, intraprostatic androgen levels could be sufficient to activate AR, contributing to PC progression. This case underscored the complexity of androgen metabolism in PC, particularly in patients with primary hypogonadism.

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