Testosterone Therapy in Patients with Treated and Untreated Prostate Cancer: Impact on Oncologic Outcomes

Area of Science:

• Urology
• Oncology
• Endocrinology

Background:

• Prostate cancer and testosterone deficiency are age-related conditions.
• Testosterone therapy is approached cautiously in prostate cancer patients due to androgen receptor activation.
• Hypogonadal men with prostate cancer require safe treatment options.

Purpose of the Study:

• To evaluate the oncological safety of testosterone therapy in hypogonadal men with prostate cancer.
• To assess outcomes in men treated with testosterone after definitive prostate cancer treatment or active surveillance.

Main Methods:

• A cohort of 82 hypogonadal men with prostate cancer receiving testosterone therapy was identified.
• Patients had undergone various treatments: radiation therapy, radical prostatectomy, active surveillance, cryotherapy, or high-intensity focused ultrasound.
• Key parameters monitored included prostate-specific antigen (PSA), testosterone levels, hemoglobin, biochemical recurrence, and PSA velocity.

Main Results:

• Median age was 75.5 years with a median follow-up of 41 months.
• Testosterone and PSA levels increased significantly in the cohort (p <0.001 and p = 0.001, respectively).
• No patients experienced Gleason score upgrades; 6% on radiation therapy had biochemical recurrence, with causality to testosterone therapy unclear. PSA velocity varied by treatment group.

Conclusions:

• Testosterone therapy may be oncologically safe for hypogonadal men with prostate cancer.
• This finding is supported in men who received definitive treatment or are on active surveillance.
• Further randomized, placebo-controlled trials are needed to confirm these results.