By 7016381070
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October 14, 2019
TESTOSTERONE AND PROSTATE CANCER: KNOW THE RISKS! In the past five years, Becker, Schroader & Chapman, PC has handled several medical malpractice cases arising out the prescription of testosterone replacement therapy, or “TRT”. These cases all share the same fact pattern: a family doctor prescribes TRT without properly testing the patient’s testosterone levels, without screening the patient for prostate cancer, and without monitoring the patient while he is on testosterone. Our expertise in this area and in medical malpractice cases has led St. Louis urologists to refer prostate cancer patients to our firm for help. We have made doctors pay when they broke the TRT rules. Background If you have watched any television over the past few years, there is no way that you could have missed the TRT ads. Aimed at men, and their significant others, TRT marketing suggests that testosterone supplements can raise “Low T” and alleviate symptoms of aging, including low sex drive, erectile dysfunction, fatigue, and even depression. Doctors have several TRT products to choose from. Androgel and Testim come in packets of clear gel and are applied topically. Depo-Testosterone is an injected directly into the muscles and the body absorbs the testosterone slowly. There are also patches and oral tablets. Even though recent trials of testosterone treatment in older men, conducted by the National Institute of Health, have generated little evidence that TRT can help many of the symptoms for which it is advertised, the TRT market is expected to reach $3.8 billion globally by 2022, up from $2 billion in 2012. The Risks The Food and Drug Administration requires TRT manufacturers to warn of several side effects and contraindications. For example, TRT is contraindicated for men with known, or suspected , prostate cancer. The most common Adverse Reaction listed in the Androgel package insert is an increase in the prostate specific antigen (PSA). The PSA is an enzyme that is produced only by the prostate. For decades, family physicians and urologists were taught that prescribing testosterone to a patient who may have prostate cancer is like pouring gasoline on a fire. The TRT will cause the cancer to grow or spread, becoming much more difficult to treat and leading to poor surgical outcomes, including impotence, urinary symptoms, and risk of the cancer returning. Although there are some recent studies that suggest a weaker link between prostate cancer and testosterone, it is undisputed that androgen deprivation therapy (“ADT”) is standard treatment for patients diagnosed with prostate cancer. Prostate cancer cells – like other living organisms – need fuel to grow and survive. Because testosterone serves as the main fuel for prostate cancer cell growth, ADT stops testosterone from being released or prevents it from acting on the prostate cells. There is no dispute in the literature that ADT works to prevent prostate cancer growth. Since lowering testosterone limits prostate cancer, raising testosterone can have the opposite effect. Other risks include worsening of benign prostate hyperplasia, deep vein thrombosis, and pulmonary embolism. The Standard of Care Despite attempts by TRT manufacturers and their paid physician advocates to debunk any health risks, the Standard of Care that family physicians and urologists must follow before prescribing testosterone remains the same. We at Becker, Schroader & Chapman, P.C. know this because we have consulted with board-certified family physicians and urologists who have provided expert opinions on behalf of our clients regarding the standard of care. The rules for TRT are: • Total testosterone concentration should be measured on two separate mornings. Anything lower than 300 ng/dl is considered low testosterone. • A Digital Rectal Exam should be performed to examine the prostate for abnormalities. • A baseline PSA should be obtained. A PSA >4 or >3 for high risk patients such as African American males is a contraindication for TRT. A referral to a urologist is required for any abnormal PSA. • The patient should be monitored to see if the TRT is working and TRT should be stopped if there is a PSA increase of > 1.4 ng/mL above baseline. https://www.endocrine.org/guidelines-and-clinical-practice/clinical-practice-guidelines/testosterone-therapy Our Experience We have helped patients whose doctors have failed to follow the TRT rules. Our cases were resolved before trial with payments made by the family physician. If a physician wants to try TRT for a patient, that is fine, but the rules have to be followed. If the rules are broken, the patient’s health is at risk. Our clients have undergone prostatectomies, chemotherapy, and radiation treatment. If the standard of care had been followed, the cancer would have been caught earlier and the patient cured. In fact, we obtained this very testimony from the urologist who operated on one of our clients. In another case, we obtained a substantial settlement after another attorney turned the case down. If you or a loved one has been diagnosed with prostate cancer after using testosterone, call us today: 618-931-1100.