Testosterone replacement therapy after primary treatment for prostate cancer

A history of prostate cancer has been an absolute contraindication for testosterone supplementation. We studied a cohort of hypogonadal patients treated with radical retropubic prostatectomy (RRP) for organ confined prostate cancer to determine if testosterone replacement therapy (TRT) could be efficacious and administered safely without causing recurrent prostate tumor.

Ten hypogonadal patients previously treated with RRP for organ confined prostate cancer were identified. They presented with low serum total testosterone (TT) and symptoms of hypogonadism after RRP. Patients had baseline serum determinations of prostate specific antigen (PSA) and TT, and were started on testosterone supplementation. They were assessed periodically for changes in PSA and TT, and for symptomatic improvement using the hormone domain of the Extended Prostate Inventory Composite Health Related Quality of Life questionnaire.

At a median followup of 19 months no patient had detectable (greater than 0.1 ng/ml) PSA. TT increased significantly after starting TRT from a mean +/- SD of 197 +/- 67 to 591 +/- 180 ng/dl (p = 0.0002). The Hormone Domain of the Extended Prostate Inventory Composite Health Related Quality of Life questionnaire increased significantly from 38 +/- 5 to 49 +/- 3 (p = 0.00005), primarily due to a decrease in hot flashes and an increase in energy level.

At a median of 19 months of TRT hypogonadal patients with a history of prostate cancer had no PSA recurrence and had statistically significant improvements in TT and hypogonadal symptoms. In highly select patients after RRP TRT can be administered carefully and with benefit to hypogonadal patients with prostate cancer.