Intermittent androgen replacement for intense hypogonadism symptoms in castrated patients

For locally advanced prostate cancer management, medical androgen deprivation and surgical castration are alternatives. These hormonal treatments may cause a myriad of side effects, such as osteoporosis with increased risk of fractures, anemia, behavioral changes and lack of sexual interest. We evaluated the feasibility of intermittent androgen replacement in surgically castrated patients with significant side effects.

Five patients with advanced prostate cancer, ranging from 71 to 77 years of age (mean age = 74 years), surgically castrated for at least 3 years, with important symptoms of hypoandrogenism received testosterone replacement. They were followed with PSA and testosterone measurement every other month and bone scans every 6 months.

For the first year all patients improved significantly, none of them showed PSA increase over 10 ng/ml. There was no evidence of local recurrence or distant disease. After 18 months, only one patient (20%) had a significant PSA increase, controlled by androgen withdrawal. No side effects or metastasis were observed.

Hormonal replacement in patients that underwent castration seems to be feasible in improving intense symptoms associated to androgen deprivation. After 18 months, no evidence of recurrence was noted. It is an experimental alternative for highly symptomatic patients, but the short follow-up and the small number of patients cannot allow for definitive conclusions and should be studied further.