The Evidence-Practice Gap in Testosterone Therapy for Prostate Cancer: A Narrative Review

Area of Science:

• Urology
• Endocrinology
• Oncology

Background:

• The historical contraindication of testosterone replacement therapy (TRT) in men with prostate cancer (PCa) is being re-evaluated.
• Current evidence suggests TRT may be safe for select PCa patients, yet clinical practice lags behind.

Purpose of the Study:

• To synthesize contemporary evidence on TRT in men with a history of PCa.
• To characterize the gap between evidence and clinical practice.
• To propose a framework for shared decision-making and surveillance.

Main Methods:

• Narrative review of current scientific literature.
• Analysis of factors contributing to the evidence-practice gap.
• Development of a clinical framework for managing TRT in PCa survivors.

Main Results:

• Growing data indicate TRT does not increase biochemical recurrence, disease progression, or PCa-specific mortality in carefully selected men.
• Clinical practice and guidelines remain conservative, leading to undertreatment of hypogonadism in PCa survivors.
• Key barriers include guideline interpretation, medico-legal concerns, and lack of randomized trials.

Conclusions:

• An absolute contraindication for TRT in men with symptomatic hypogonadism and a history of treated PCa is no longer tenable.
• These patients warrant evidence-informed discussions regarding TRT.
• A practical framework for shared decision-making and surveillance is proposed.