Testosterone Therapy in Patients with Treated and Untreated Prostate Cancer: Impact on Oncologic Outcomes

Abstract

Purpose Both testosterone deficiency (TD) and prostate cancer (CaP) have increasing prevalence with age. However, because of the relationship between CaP and androgen receptor activation, testosterone therapy (TT) among patients with known CaP has been approached with caution. Materials and Methods We identified a cohort of 82 hypogonadal men with CaP who were treated with TT. These included 50 men treated with Radiation Therapy (XRT), 22 with Radical Prostatectomy (RP), 8 managed with Active Surveillance (AS), 1 with Cryotherapy and 1 with High-Intensity Focused Ultrasound. We monitored prostate specific antigen (PSA), testosterone, hemoglobin, biochemical recurrence (BCR) and PSA Velocity (PSAV). Results Median patient age was 75.5 years and median follow up was 41 months. We found an increase in both testosterone (p<0.001) and PSA (p=0.001) levels in the entire cohort. PSA increased in the AS patients, however no patients were upgraded to higher Gleason Score on subsequent biopsies, and none have yet gone on to definitive treatment. We did not have any cases of BCR amongst RP patients, but 3 XRT patients (6%) experienced BCR. It is unclear whether these were related to TT or reflected the natural biology of their disease. We calculated the mean PSAV to be 0.001, 0.12, and 1.1 ug/L/yr for the RP, XRT, and AS groups, respectively. Conclusions In the absence of randomized placebo controlled trials, our study supports the hypothesis that TT may be oncologically safe in hypogonadal men following definitive treatment or active surveillance for CaP.

Testosterone therapy and prostate cancer

“…Also in 2016, Ory et al examined 82 hypogonadal men with CaP treated using either radiation therapy, radical prostatectomy, AS, cryotherapy or high-intensity focused ultrasound and on TTh. Of the eight men on AS, none required treatment of CaP after a mean follow-up of 27 months (96). Preliminary data examining men with advanced CaP on TTh also support efficacy of TTh without an increased risk of CaP progression.…”

Late-onset Hypogonadism and Testosterone Therapy – A Summary of Guidelines from the American Urological Association and the European Association of Urology

“…Both guidelines acknowledge important limitations in available studies on TT and PCA, including a lack of long-term follow-up data. For patients who have previously undergone PCA treatment with curative intent, available series do not demonstrate an increased risk of recurrence with TT [48][49][50][51][52][53][54]. The EAU guidelines recommend that TT be "cautiously considered" at a minimum of 1 yr following treatment of low-risk PCA with no signs of recurrence.…”

“…The AUA guideline recommends that all patients are candidates for TT following successful surgery or radiation therapy, subject to risk stratification. Data on TT for men on active surveillance for PCA are very limited [54][55][56][57]. Very few data exist on TT in the context of focal therapy for PCA (eg, high-intensity focused ultrasound and cryotherapy).…”

Testosterone Therapy on Active Surveillance and Following Definitive Treatment for Prostate Cancer

“…Of the men treated with RP, none were noted to have a biochemical recurrence [18 •• ]. The conclusion from these studies seems to show no appreciable increase in prostate cancer recurrence in testosterone-deficient men treated with testosterone after a radical prostatectomy [21, 22, 23••, 24].…”