Testosterone Replacement Therapy in Patients with Prostate Cancer After Radical Prostatectomy
Open accessAbstract
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: We performed a review of 103 hypogonadal men with prostate cancer treated with testosterone after prostatectomy (treatment group) and 49 nonhypogonadal men with cancer treated with prostatectomy (reference group). There were 77 men with low/intermediate (nonhigh) risk cancer and 26 with high risk cancer included in the analysis. All men were treated with transdermal testosterone, and serum hormone, hemoglobin, hematocrit and prostate specific antigen were evaluated for more than 36 months. RESULTS: Median (IQR) patient age in the treatment group was 61.0 years (55.0-67.0), and initial laboratory results included testosterone 261.0 ng/dl (213.0-302.0), prostate specific antigen 0.004 ng/ml (0.002-0.007), hemoglobin 14.7 gm/dl (13.3-15.5) and hematocrit 45.2% (40.4-46.1). Median followup was 27.5 months, at which time a significant increase in testosterone was observed in the treatment group. A significant increase in prostate specific antigen was observed in the high risk and nonhigh risk treatment groups with no increase in the reference group. Overall 4 and 8 cases of cancer recurrence were observed in treatment and reference groups, respectively. CONCLUSIONS: Thus, testosterone therapy is effective and, while followed by an increase 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 performed with a vigorous surveillance protocol.
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Limited data have demonstrated no significant increases in prostate cancer recurrence in men treated with testosterone compared to controls after radical prostatectomy.
“Limited data have demonstrated no significant increases in prostate cancer recurrence in men treated with testosterone compared to controls”
From Evaluation and Management of Testosterone Deficiency: AUA Guideline (2018) · cites this paper as [36]
An increase in PSA among men in high-risk groups receiving testosterone after radical prostatectomy has been shown.
“although an increase in PSA among men in high-risk groups receiving testosterone has been shown”
From Evaluation and Management of Testosterone Deficiency: AUA Guideline (2018) · cites this paper as [36]
Insufficiently powered studies that conclude safety of testosterone supplementation in men with prostate cancer are at risk of type-II errors and are not statistically supportable.
“As such, insufficiently powered studies which conclude safety of T supplementation in men with prostate cancer are at risk of committing type-II errors and are not statistically supportable.143, 144”
From Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials (2016) · cites this paper as [144]
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- Authors
- Pastuszak, A. W., Pearlman, A. M., Lai, W. S., Godoy, G., Sathyamoorthy, K., Liu, J. S., Miles, B. J., Lipshultz, L. I., & Khera, M.
- Affiliations
- Baylor College of Medicine (US)
- University of Pennsylvania (US)
- Northwestern University (US)
- Houston Methodist (US)
- ORCID
- Venue
- Journal of Urology
- Published
- 2013-08
- Volume
- 190
- Issue
- 2
- Pages
- 639-644
- ISSN
- 0022-5347 (ISSN-L)
- 1527-3792
- PMC
- PMC4544840
- OpenAlex
- W2091445581
- Cited by
- 183
- References
- 33
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 9 · 2023: 9 · 2022: 18 · 2021: 6 · 2020: 15 · 2019: 15 · 2018: 11 · 2017: 10 · 2016: 13 · 2015: 27 · 2014: 26 · 2013: 6
- FWCI
- 18.92
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Urology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (K23CA160664)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Treatment and Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Diagnosis and Treatment
- Keywords
- testosterone replacement therapy, prostate cancer, radical prostatectomy, hypogonadism, transdermal testosterone, prostate-specific antigen, tumor recurrence, high-risk prostate cancer, low-risk prostate cancer, hemoglobin, hematocrit, hormone therapy safety
- MeSH terms
- Aged, Hematocrit, Hemoglobins, Humans, Hypogonadism, Male, Middle Aged, Prostatectomy, Prostatic Neoplasms, Retrospective Studies, Testosterone, Linear Models, Treatment Outcome, Prostate-Specific Antigen, Statistics, Nonparametric, Hormone Replacement Therapy
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