COMMENTARY

AUA 2019: More Evidence That Testosterone May Be Safe After Treatment for Prostate Cancer

Gerald Chodak, MD

Disclosures

August 13, 2019

This transcript has been edited for clarity.

Hello. I'm Dr Gerald Chodak for Medscape. Today's topic is the use of testosterone replacement therapy (TRT) for hypogonadal men who have been treated for prostate cancer.

This topic has been controversial for quite some time. We know that prostate cancer cells are stimulated by testosterone and the primary treatment for advanced disease is to lower serum testosterone. Therefore, why would we give t TRT to a man with prostate cancer?

Several presentations at the recent American Urological Association annual meeting addressed this question. Parsons and his colleagues[1,2] presented two studies on this topic, one of men who had undergone surgery and another of men who had been treated with radiation. Both of these cohorts were from the Veterans Health Administration.

The first cohort[1] comprised nearly 29,000 men who had undergone radical prostatectomy for node-negative, nonmetastatic prostate cancer. About 1.6% of them received TRT at a median of 3.5 years after their surgeries. The TRT and non-TRT groups were similar in terms of T stage, post-op prostate-specific antigen (PSA), and use of androgen deprivation therapy. The investigators found no significant difference between the groups in terms of overall survival, cancer-specific survival, and biochemical disease-free survival.

The second cohort[2] involved about 42,000 men who had been treated with radiation for node-negative, nonmetastatic prostate cancer. About 1.3% of these men received TRT. Again, there was no significant difference between TRT and non-TRT groups in the Charlson comorbidity score, pre-op PSA, Gleason score, or T stage. These men were treated from 2001 to 2015. Here, too, there was no significant difference in overall survival, cancer-specific survival, and biochemical disease-free survival.

Neither of these cohorts showed any evidence of a problem from receiving TRT after diagnosis and treatment for prostate cancer. On the other hand, neither of these studies, and none of the others that have been presented, clearly prove that TRT is safe. Nevertheless, there is not an obvious risk to patients from these trials and, when presented with the information on the risks and benefits, most men are likely to make a quality-of-life decision, choosing TRT in order to restore their sexual function.

I look forward to your comments. Thank you.

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