Testosterone Therapy Safe Despite Prostate Cancer History

10.06.2018

Testosterone replacement therapy (TRT) for men with a history of prostate cancer (PCa) does not increase recurrence rates following radical treatment or progression rate after placement on active surveillance, investigators reported at the American Urological Association 2018 annual meeting.

In a study examining the outcomes of 190 men with PCa (mean age 68 years) who received TRT after diagnosis and/or treatment for PCa over the previous 5 years, reserchers found that biochemical recurrence rates after radical prostatectomy (RP) and radiation therapy, and the progression rate while on active surveillance (AS), were consistent with published rates from other studies.

After a mean follow-up of 47 months, the recurrence rates were 11.6% among the 86 men who underwent RP and 4.1% among the 49 men who had either external beam radiation therapy or brachytherapy. None of the 5 men treated with RP followed by salvage radiation had recurrence. The progression rate among the 47 men on AS was 10.6%.

For decades, physicians have feared offering testosterone therapy to men with prostate cancer because we were taught that raising testosterone would be like 'pouring gasoline on a fire.' From this study, and smaller studies before it, we know this concept can no longer be correct.

In a separate study presented at the conference, Unwanaobong Nseyo, MD, and colleagues at the University of California, San Diego, looked at outcomes among 123 men who were on AS for PCa-61 on TRT and a matched group of 62 patients not on TRT. The groups had similar proportions of men with a positive family history of PCa (15.7% vs 16.7%).

Overall, 11 men experienced progression on repeat biopsy during AS (5 in the TRT group and 6 in the non-TRT group). All 5 patients who progressed in the TRT arm and only 1 who progressed in the non-TRT arm underwent definitive treatment due to pathologic progression.

Men in the TRT group were diagnosed at lower PSA values than those in the non-TRT group (3.1 vs 5.3 ng/mL).

Dr Nseyo's group concluded that their data suggest that aggressive screening or treatment is not indicated for men undergoing TRT, but TRT might alter patient choice of definitive treatment during AS.

References

Morgentaler A, Magauran D, Neel D, et al. Recurrence rates following testosterone therapy in a large clinical cohort of men with prostate cancer. Data presented in poster format at the American Urological Association 2018 annual meeting in San Francisco, May 18-21. MP17-03.

Nseyo U, Unterberg S, Hsieh M. Testosterone supplementation does not increase the risk of prostate cancer progression but might alter patient choice for definitive treatment during active surveillance. Data presented in poster format at the American Urological Association 2018 annual meeting in San Francisco, May 18-21. MP17-09.