Outcomes of Prostate Biopsy in Men with Hypogonadism Prior or During Testosterone Replacement Therapy

Abstract

Introduction:The relationship between Testosterone Replacement Therapy (TRT) and prostate cancer remains controversial. Most TRT studies show no change in prostate specific antigen (PSA) but some men do have PSA rise or develop an abnormal digital rectal exam (aDRE). Our objective was to examine the biopsy results of men with symptomatic hypogonadism before or during therapy.Materials and Methods:Data was extracted from our medical record on men with hypogonadism who had a prostate biopsy within the past 4 years done by 3 Urologists with guideline driven practice patterns.Results:96 men were identified. Mean age at biopsy was 63 (range 40–85) and median PSA was 3.78ng/dL (0.5–662). Of the 61 men not on TRT, median PSA was 4.34 (0.5 to 662) and mean total testosterone 254 (191–341). There were 29 (47.5%) prostate cancers found (6 Gleason score 6, 13 Gleason score 7, 10 Gleason score 8 or 9). Of the 35 men on TRT, median PSA was 3.27 (0.5 to 13.7). The %PSA increase ranged from 2 to 251% (mean 93.5%). Mean total testosterone was 383 (146–792). Of the 14 men treated < 2 years, none had cancer. Of the 21 men treated 2 or more years 5 had cancer (2 Gleason score 6, 3 Gleason score 7).Conclusions:Men with hypogonadism and a clinical indication for biopsy often have prostate cancer, many high grade. No men with an initial PSA rise on TRT had cancer. Men on long term TRT should be monitored with PSA and DRE per guidelines.

Hypogonadism and urologic surgeries: a narrative review

“…According to current guidelines, TRT is contraindicated in the presence of hormone-responsive tumors including prostate carcinoma ( 15 , 75 ); however, the impact of hypogonadism and TRT on prostate cancer progression and disease course is controversial ( 76 , 77 ). In 1996, Gann et al demonstrated the association between high serum testosterone concentration and enhanced risk of prostate carcinoma ( 78 ).…”

“…Hugosson et al evaluated the efficacy of neoadjuvant hormone treatment by triptorelin and cyproterone acetate prior to radical prostatectomy which resulted in reduced risk of malignancy in surgical margins (82). On the contrary, several investigations suggested that TRT is not related to increased risk of developing prostate cancer (76,77). Also, androgen deficiency is associated with insulin resistance and increased leptin levels which could ultimately lead to higher mortality, recurrence, and metastasis in prostate carcinoma patients (83).…”