Testosterone Therapy and Prostate Cancer: Incorporating Low-Level Evidence into Practical Recommendations

The widely accepted absolute contraindication for administration of testosterone in hypogonadal men with prostate cancer has been questioned. Although recommendations from some professional associations still adhere to the traditional concepts, there is increasing relaxation of such positions. Currently, the evidence for definitive guidelines is unavailable and the clinician has to rely on incomplete but best attainable information. Under certain circumstances (successfully treated prostate cancer or active surveillance for low risk disease), testosterone administration is warranted. For those with intermediate or high-risk cancer, extreme caution seems advisable. The benefits must heavily outweigh the hazards. Ideally, these men should participate in clinical trials and registries. Competent initial assessment of individual circumstances and follow-up are mandatory.