Testosterone Therapy in Men after Radical Prostatectomy for Organ-Confined, Low-Intermediate Prostate Cancer - Beyond the Abstract
A Cox model was created for time to biochemical recurrence with testosterone use included as a time-dependent covariate, adjusted for age, pre-operative PSA, grade group at radical prostatectomy, and the presence of comorbidities. A landmark analysis was used: patients were included in the analysis if their last PSA in the 18 weeks post-operatively was undetectable and they had not had biochemical recurrence or been lost to follow-up by that point, and follow-up for biochemical recurrence began at 18 weeks. Biochemical recurrence was defined as a PSA ≥ 0.1 ng/mL post-radical prostatectomy with a second confirmatory rise ≥ 0.1 ng/mL.
We observed in a population study of 5,199 men post-radical prostatectomy, 5,001 not receiving testosterone therapy and 198 receiving testosterone therapy that in this carefully selected population of patients with organ-confined, grade group 1-3 prostate cancer treated after surgery, and we found a non-significantly decreased risk of biochemical recurrence associated with the use of testosterone after radical prostatectomy (HR 0.84, 95% CI 0.48, 1.46; p=0.5), and overall rates of biochemical recurrence were low, with probability of biochemical recurrence at five years less than 2% in both groups.
In this study, which included the largest sample size reported and the optimal methodology to analyze testosterone therapy in this selected group of men with organ-confined prostate cancer and grade groups 1 – 3 on surgical pathology, we found no evidence that testosterone therapy increases the risk of biochemical recurrence after surgery.
Written by: Jose M. Flores, MD, MHA, Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
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