Testosterone Replacement Therapy in Hypogonadal Men Following Prostate Cancer Treatment: A Questionnaire-Based Retrospective Study among Urologists in Bavaria, Germany

Kühn, Charlotte Marie; Strasser, Hans; Romming, Alexander; Wullich, Bernd; Goebell, Peter J.

doi:10.1159/000371725

Cited by 9 publications

(20 citation statements)

References 35 publications

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“…A 2015 electronic survey of North American members of the Sexual Medicine Society of North America (SMSNA) revealed that a current or previous diagnosis of prostate cancer did not hinder physicians from prescribing TRT (41). These findings contrasted with a similarly designed 2015 German study which showed that German urologists were far less likely than their American counterparts to prescribe TRT to patients with a history of prostate cancer (42). …”

Section: Testosterone Prescribing Patternscontrasting

confidence: 68%

Testosterone deficiency in adults and corresponding treatment patterns across the globe

Anaissie

DeLay

Wang

et al. 2017

Transl. Androl. Urol.

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The global prevalence of testosterone deficiency (TD) ranges from 10–40%. The actual diagnosis of TD is controversial, as a wide range of total testosterone (TT) thresholds are used for diagnosis (200–400 ng/dL), and physicians differ in their emphasis placed on clinical symptoms. There are also significant global differences in the prescription patterns of testosterone replacement therapy (TRT). In the United States, prescription of TRT is significantly higher than the rest of the world, increasing 3-fold over the last 10 years and more so in eugonadal men. The majority of treating physicians emphasizes clinical symptomology of TD over laboratory values, and up to one-fourth of their patients do not even have serum testosterone levels. There are significant inter-physician differences in willingness to prescribe TRT in the setting of prostate cancer. Data is scarce on testosterone prescribing patterns in Africa, Asia, and the Middle East. More literature is needed to better characterize how physicians from different regions diagnose TD.

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Section: Testosterone Prescribing Patternscontrasting

confidence: 68%

Testosterone deficiency in adults and corresponding treatment patterns across the globe

Anaissie

DeLay

Wang

et al. 2017

Transl. Androl. Urol.

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“…In a recent German survey-based retrospective study, researchers sent questionnaires to all registered urologists in Bavaria, Germany [65]. Forty-six percent ( n = 193) responded to the request, which inquired about the urologist's experience with testosterone therapy in men with a history of prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Forty-six percent ( n = 193) responded to the request, which inquired about the urologist's experience with testosterone therapy in men with a history of prostate cancer. Among the 193 urologists, only 32 cases of testosterone therapy in men with prostate cancer were reported [65]. In a 2012 description of international testosterone utilization patterns, Gooren and Behre [11] provide updated follow-up data from a prior 2006 analysis to compare usage in 2010.…”

Section: Discussionmentioning

confidence: 99%

Testosterone Therapy in Men With Prostate Cancer

Kaplan

Morgentaler

et al. 2016

European Urology

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Context The use of testosterone therapy in men with prostate cancer was previously contraindicated, although recent data challenge this axiom. Over the past 2 decades, there has been a dramatic paradigm shift in beliefs, attitude, and treatment of testosterone deficiency in men with prostate cancer. Objective To summarize and analyze current literature regarding the effect of testosterone replacement in men with prostate cancer. Evidence acquisition We conducted a Medline search to identify all publications related to testosterone therapy in both treated and untreated prostate cancer. Evidence synthesis The historical notion that increasing testosterone was responsible for prostate cancer growth was based on elegant yet limited studies from the 1940s and anecdotal case reports. Current evidence reveals that high endogenous androgen levels do not increase the risk of a prostate cancer diagnosis. Similarly, testosterone therapy in men with testosterone deficiency does not appear to increase prostate cancer risk or the likelihood of a more aggressive disease at prostate cancer diagnosis. Androgen receptor saturation (the saturation model) appears to account for this phenomenon. Men who received testosterone therapy after treatment for localized prostate cancer do not appear to suffer higher rates of recurrence or worse outcomes; although studies to date are limited. Early reports of men on active surveillance/watchful waiting treated with testosterone have not identified adverse progression events. Conclusions An improved understanding of the negative effects of testosterone deficiency on health and health-related quality of life—and the ability of testosterone therapy to mitigate these effects—has triggered a re-evaluation of the role testosterone plays in prostate cancer. An important paradigm shift has occurred within the field, in which testosterone therapy may now be regarded as a viable option for selected men with prostate cancer suffering from testosterone deficiency. Patient summary In this article, we review and summarize the existing literature surrounding the use of testosterone therapy in men with prostate cancer. Historically, testosterone was contraindicated in men with a history of prostate cancer. We show that this contraindication is unfounded and, with careful monitoring, its use is safe in that regard.

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“…Of 72 relevant studies, 13 met criteria for inclusion (3,10,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Primary human studies were included, and reviews, systematic reviews and meta-analyses were excluded.…”

Section: Study Selectionmentioning

confidence: 99%

“…For these studies, the authors' definition of high risk was accepted. Six of the included studies were not designed to group patients by risk level (3,28,30,(33)(34)(35), but included sufficient information to ascertain patients' risk level using the d'Amico criteria.…”

Section: Data Extractionmentioning

confidence: 99%

Testosterone Therapy for High-risk Prostate Cancer Survivors: A Systematic Review and Meta-analysis

Teeling

Raison

Shabbir

et al. 2019

Urology

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word count: 100Manuscript text word count: 3763 Abstract A systematic review and meta-analysis was performed to determine the relationship between testosterone therapy and risk of recurrence in testosterone-deficient survivors of curatively treated high-risk prostate cancer. Primary outcome was the risk of biochemical recurrence (BCR) in 109 high-risk patients in 13 included studies . Biochemical and symptomatic effects of therapy were also reviewed. The BCR rate was 0.00 (0.00-0.05), lower than the expected rate for high-risk prostate cancer survivors, suggesting that testosterone therapy may not increase their BCR risk. However, this is uncertain as the available evidence is of very low quality. Testosterone therapy remains investigational in this group.

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Testosterone Replacement Therapy in Hypogonadal Men Following Prostate Cancer Treatment: A Questionnaire-Based Retrospective Study among Urologists in Bavaria, Germany

Cited by 9 publications

References 35 publications

Testosterone deficiency in adults and corresponding treatment patterns across the globe

Testosterone deficiency in adults and corresponding treatment patterns across the globe

Testosterone Therapy in Men With Prostate Cancer

Testosterone Therapy for High-risk Prostate Cancer Survivors: A Systematic Review and Meta-analysis

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