PURPOSE: The relationship between recurrent prostate cancer risk and testosterone replacement therapy (TRT) for hypogonadal men is explored.
SUMMARY: The medical literature was searched to identify articles evaluating the use of TRT in symptomatic hypogonadal men with a history of prostate cancer. Eight English-language articles investigating TRT use in hypogonadal men with a history of prostate cancer were analyzed. For evaluative purposes, the normal ranges used for prostate-specific antigen (PSA) and total testosterone levels were less than 4.0 ng/mL and 300-1000 ng/dL, respectively. Most trials were small and involved patients with localized prostate cancer treated with radical prostatectomy or radiotherapy, though patients with metastatic disease or a Gleason score of ≥8 were included in a few studies. TRT was administered in a variety of dosages and dosage forms for up to nine years to manage hypogonadal symptoms. Testosterone concentrations increased, as expected, after TRT, but serum PSA levels remained below 0.1 ng/mL in the majority of patients. PSA levels were found to increase in select patients with high-risk and metastatic disease, but these elevations were not accompanied by disease progression. These studies have suggested a potential benefit for TRT use in select symptomatic hypogonadal men with a history of prostate cancer. Data were limited, however, by the retrospective nature of most studies, the lack of control groups, small sample sizes, and short follow-up periods.
CONCLUSION: There is insufficient evidence to withhold TRT in certain populations of men with a history of prostate cancer.
Written by:
Gray H, Seltzer J, Talbert RL. Are you the author?
Remote Prescription Approval System Pharmacist, Hunter Pharmacy Services, Austin, TX; Pharmacotherapy Division, College of Pharmacy, University of Texas at Austin, San Antonio; Pharmacotherapy Division, College of Pharmacy, University of Texas at Austin, San Antonio.
Reference: Am J Health Syst Pharm. 2015 Apr 1;72(7):536-41.
doi: 10.2146/ajhp140128
PubMed Abstract
PMID: 25788507