Plenary Session 1: Courting controversy, providing answers

EAU14’s first plenary session on “Andrology in Healthy Ageing” was everything a plenary session should be: informative and controversial, and combining the best of basic research with good clinical practice.

Prof. Wolfgang Weidner (DE) began with an overview of the current state of male infertility treatment. From the point of view of urologists specialising in andrology, the main problem may be how to obtain and select the best sperm, but there can be many other factors involved. He advocated a team-led approach involving not just urologists but, for example, counsellors, endocrinologists, oncologists, and other fertility specialists, depending on the individual’s circumstances.

Prof. Stefan Arver from the Karolinska in Stockholm (SE) reviewed the pros and cons of testosterone supplementation in the ageing male. His main message was that a diagnosis of hypogonadism is not a case of finding a testosterone level above or below a threshold, but that good clinical judgment has a huge role to play. Controversy was introduced by Dr. John Mulhall, from the Sloan Kettering Institute in New York (US), with his state-of-the-art lecture on the real or imagined dangers of testosterone supplementation. Dr. Mulholl stepped the audience through the recent media storm in the US and Europe, provoked by three papers in top-rated journals calling into question the safety of testosterone supplementation. As he said, this is a real and ongoing public health issue, with “patients requesting to stop therapy because of what they have read in the media”. Reviewing the methodologies of each paper, he showed how each displayed a degree of “bad science”. He also revealed that 25 medical societies have written to the editors of the journal which published the most recent paper, asking for a retraction because of methodological problems. We await this one with interest!Dr. Maarten Albersen of the Laboratory of Experimental Urology in Leuven (BE) provided the basic science – which is on the verge of moving towards real clinical applications. For a detailed overview of his presentation on stem cell research in erectile dysfunction, see his article in the first edition of “EUT Congress News”.

Summarising the session, Co-Chair Professor Jens Sønksen said: “This was a stimulating session. As we have seen, there is an ongoing controversy on the testosterone use and cardiovascular disease (CVD). There have been 3 recent papers – 2 in the last couple of months alone – suggesting that testosterone use is linked to higher rates of CVD. These papers were all published in high-quality journals, but the work presented today really calls the methodologies of these papers into question. So we need new studies, we need really good RCTs to show whether there is any real problem or not.

The basic research is also very exciting. For years we have been discussing animal studies, and sometimes we have seemed very far away from translating these animal results into something which would really benefit patients. But now we seem to really be on the verge of moving forward. For a long time we have been producing abstracts rather than answers, now it looks like we may be moving towards real answers”.