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- Can Testosterone Improve Outcomes For Men With Glioblastoma?
Can Testosterone Improve Outcomes For Men With Glioblastoma?
There are several different kinds of glioma, brain tumours that arise in the glial cells in the brain and spinal cord. However, the most aggressive of these is a glioblastoma. It is also the most common.
Glioblastomas emerge from star-shaped cells known as astrocytes and were originally classed as the most aggressive form of astrocytoma. However, they are now usually categorised separately.
Key features of glioblastomas include:
Treatments for glioblastoma include:
Radiotherapy can be very effective in slowing down the progression of a glioblastoma, although the tumour does have some capacity to repair radiation-damaged DNA. However, this takes time and energy, meaning that the tumour will shrink in the meantime.
However, while these are important and effective forms of treatment that can slow the progression of this form of cancer, research is constantly taking place into further treatments that can be used alongside them. One new development may particularly help men.
However, recent research has indicated a likely difference based on sex hormones, opening up new possibilities for treatment.
A study by Cleveland Clinic in the US, published in the journal Nature, highlighted the potential role of androgens, which include testosterone, which act to suppress anti-T cell immunity, therefore aiding tumour progression.
However, the effect of androgens depends on where in the body the tumour is, and previous work had not focused on this question in relation to brain tumours.
The research on mice found that androgen reduction, caused by castration, could reduce tumour progression in tumours away from the brain, but for brain tumours, the reverse was true, with more testosterone appearing to slow progression.
A notable finding was that the effects were evident in male mice, but not in females.
This challenges the old blanket assumption that androgens are always part of the problem. Instead, the research found that the addition of extra testosterone helped brain tumour patients survive for longer because it slowed the progression of the tumours.
A key difference is that the brain deals with immune responses in a different way than other organs. Elsewhere, the immune response leads to more inflammation, but the sensitive nature of brain tissue would make this counterproductive for the brain.
To deal with this, the brain responds differently to androgens, effectively sealing itself off and not allowing immune cells from elsewhere in the body to enter.
The link between testosterone and better glioblastoma outcomes in men was revealed by studying brain tumour patients who were receiving testosterone supplements for non-cancer reasons, who had better outcomes than those who were not receiving them.
As with any research, much more needs to be done to establish testosterone supplements as an effective treatment for men with glioblastoma, although some may take part in clinical trials.
So far, the only evidence not involving lab mice comes from those men who were taking testosterone for other reasons.
If testosterone is used for this purpose and proves effective, it will still not provide a complete cure for glioblastoma, nor obviate the need for other treatments. Surgery, radiotherapy and chemotherapy will remain important options.
Instead, what may happen is that testosterone treatment will be used in combination with other measures, just as surgery and radiotherapy are often used in succession.
What is clear is that as research continues, new treatments can and will emerge that offer potentially better outcomes for patients who have this most aggressive form of tumour.
As they do, we will continue to offer the latest treatments and technologies in personalised programmes that place the individual patient at the heart of everything we do.
Learn more about our advanced radiotherapy and neurosurgical treatments for glioblastoma on the Queen Square website.
Glioblastomas emerge from star-shaped cells known as astrocytes and were originally classed as the most aggressive form of astrocytoma. However, they are now usually categorised separately.
Key features of glioblastomas include:
- They are always malignant (cancerous), whereas some forms of astrocytoma are not.
- They are all classed at Grade 4, which means they are in the most aggressive (fast-growing) category.
- They account for 32 per cent of all gliomas.
How Are Glioblastomas Treated At Present?
Because they are so fast-growing, the prognosis for patients is worse than with other tumours, which means there needs to be a swift and radical treatment response once the diagnosis has been made.Treatments for glioblastoma include:
- Surgery to remove as much of the tumour as possible
- Radiotherapy to shrink the tumour by breaking down the DNA in cancerous cells
- Chemotherapy, which contains drugs that are toxic to cancer cells
Radiotherapy can be very effective in slowing down the progression of a glioblastoma, although the tumour does have some capacity to repair radiation-damaged DNA. However, this takes time and energy, meaning that the tumour will shrink in the meantime.
However, while these are important and effective forms of treatment that can slow the progression of this form of cancer, research is constantly taking place into further treatments that can be used alongside them. One new development may particularly help men.
How Has Research Overturned Old Ideas About The Relationship Of Testosterone To Tumours?
It has long been known that men are more likely than women to develop a glioblastoma, while women who do suffer from the tumours experience a better response to treatment. However, for a long time, it was not known why this gender imbalance exists.However, recent research has indicated a likely difference based on sex hormones, opening up new possibilities for treatment.
A study by Cleveland Clinic in the US, published in the journal Nature, highlighted the potential role of androgens, which include testosterone, which act to suppress anti-T cell immunity, therefore aiding tumour progression.
However, the effect of androgens depends on where in the body the tumour is, and previous work had not focused on this question in relation to brain tumours.
The research on mice found that androgen reduction, caused by castration, could reduce tumour progression in tumours away from the brain, but for brain tumours, the reverse was true, with more testosterone appearing to slow progression.
A notable finding was that the effects were evident in male mice, but not in females.
This challenges the old blanket assumption that androgens are always part of the problem. Instead, the research found that the addition of extra testosterone helped brain tumour patients survive for longer because it slowed the progression of the tumours.
A key difference is that the brain deals with immune responses in a different way than other organs. Elsewhere, the immune response leads to more inflammation, but the sensitive nature of brain tissue would make this counterproductive for the brain.
To deal with this, the brain responds differently to androgens, effectively sealing itself off and not allowing immune cells from elsewhere in the body to enter.
The link between testosterone and better glioblastoma outcomes in men was revealed by studying brain tumour patients who were receiving testosterone supplements for non-cancer reasons, who had better outcomes than those who were not receiving them.
How Could These Findings Change Glioblastoma Treatments?
Commenting on the findings, scientific director of the Brain Tumour Centre at Cleveland Clinic, Professor Justin Lathia, said: “This outcome is a welcome surprise and may potentially offer a lead for new treatments”.As with any research, much more needs to be done to establish testosterone supplements as an effective treatment for men with glioblastoma, although some may take part in clinical trials.
So far, the only evidence not involving lab mice comes from those men who were taking testosterone for other reasons.
If testosterone is used for this purpose and proves effective, it will still not provide a complete cure for glioblastoma, nor obviate the need for other treatments. Surgery, radiotherapy and chemotherapy will remain important options.
Instead, what may happen is that testosterone treatment will be used in combination with other measures, just as surgery and radiotherapy are often used in succession.
What is clear is that as research continues, new treatments can and will emerge that offer potentially better outcomes for patients who have this most aggressive form of tumour.
As they do, we will continue to offer the latest treatments and technologies in personalised programmes that place the individual patient at the heart of everything we do.
Learn more about our advanced radiotherapy and neurosurgical treatments for glioblastoma on the Queen Square website.
