PURPOSE: Testosterone replacement therapy in men with prostate cancer is controversial, with concern that testosterone can stimulate cancer growth.
We evaluated the safety and efficacy of testosterone in hypogonadal men with prostate cancer treated with radical prostatectomy.
MATERIALS AND METHODS: Review of 103 hypogonadal men with prostate cancer treated with testosterone after prostatectomy (treatment group) and 49 non-hypogonadal men with cancer treated with prostatectomy (reference group) was performed. Seventy-seven men with low/intermediate (non-high) risk and 26 with high-risk cancer were included. All men were treated with transdermal testosterone and serum hormone, hemoglobin, hematocrit, and prostate specific antigen levels evaluated for >36 months.
RESULTS AND CONCLUSIONS: Median (IQR) age in the treatment group was 61.0 (55.0-67.0) years, and initial labs included testosterone 261.0 (213.0-302.0) ng/dL, prostate specific antigen 0.004 (0.002-0.007) ng/ml, hemoglobin 14.7 (13.3-15.5) g/dL, and hematocrit 45.2 (40.4-46.1) %. Median follow-up was 27.5 months, at which time significant increase in testosterone was observed in the treatment group. A significant increase in prostate specific antigen was observed in high and non-high risk treatment groups with no increase in the reference group. Four and eight cancer recurrences were observed in treatment and reference groups, respectively. Thus, testosterone therapy is effective and, while followed by a rise in prostate specific antigen, does not appear to increase cancer recurrence rates, even in men with high-risk prostate cancer. However, given the retrospective nature of this and prior studies, testosterone therapy in men with history of prostate cancer should be undertaken with a vigorous surveillance protocol.
Written by:
Pastuszak AW, Pearlman AM, Lai WS, Godoy G, Sathyamoorthy K, Liu JS, Miles BJ, Lipshultz LI, Khera M. Are you the author?
Scott Department of Urology, Baylor College of Medicine, Houston, TX.
Reference: J Urol. 2013 Feb 7. pii: S0022-5347(13)00259-0.
doi: 10.1016/j.juro.2013.02.002
PubMed Abstract
PMID: 23395803
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