Testosterone replacement in prostate cancer survivors with hypogonadal symptoms

To describe the clinical outcomes of prostate cancer survivors who were treated with high-dose testosterone-replacement therapy (TRT) for the relief of hypogonadal symptoms.

We reviewed the records of 96 patients who received TRT after initial management for prostate cancer from 2000 to 2007.

In all, 41 men had prostate-specific antigen (PSA) progression (PSA Working Group) while on TRT, but only seven had radiographic progression of disease. Fifty-six men discontinued TRT due to increasing PSA levels, and 59% of these men had significant reductions in PSA level with no additional intervention. In all, 31 men remain on TRT with no PSA or radiological progression at a median of 36.7 months; nine men stopped TRT for reasons other than progression. Characteristics associated with continuing TRT were radical prostatectomy as primary management, a low PSA level when starting TRT, and concurrent use of dutasteride. Hypogonadal symptoms were alleviated in most cases.

While most men in this series had increasing PSA levels during TRT, stopping TRT typically resulted in PSA declines. A subset of men were able to remain on TRT for several years without disease progression.