Testosterone replacement therapy in men with prostate cancer: a time-varying analysis

Area of Science:

• Oncology
• Endocrinology
• Men's Health

Background:

• Testosterone replacement therapy (TRT) use in men with prostate cancer is controversial due to concerns about androgen-driven cancer progression.
• Emerging evidence suggests TRT may be safe, but dose-related effects remain uninvestigated.

Purpose of the Study:

• To determine if increasing TRT exposure is associated with adverse outcomes in men with prostate cancer using time-varying analysis.
• To investigate the relationship between TRT duration and mortality or need for salvage androgen deprivation therapy (ADT).

Main Methods:

• Utilized linked Surveillance, Epidemiology, and End Results-Medicare data for 149,354 men diagnosed with prostate cancer (1991-2007).
• Stratified men treated with TRT by treatment duration and used weighted propensity score methods for adjustment.
• Employed a Cox proportional hazards model to assess the impact of injectable TRT exposure on outcomes.

Main Results:

• TRT, irrespective of duration, was not linked to increased overall mortality (OM) or prostate cancer-specific mortality (PCSM). Hazard ratios (HR) for OM and PCSM were <1.0 (P ≤ 0.002).
• No significant difference in salvage ADT use was observed for TRT durations of ≤30 days (HR 1.23) or 31-60 days (HR 1.05) compared to no TRT.
• Long-term TRT use was associated with a lower need for salvage ADT (HR 0.70, P=0.04).

Conclusions:

• Testosterone replacement therapy following prostate cancer diagnosis and treatment does not elevate mortality rates or the requirement for salvage ADT.
• Time-varying analysis confirms that extended TRT duration is not associated with adverse mortality outcomes or increased need for ADT.