Testosterone Therapy Safe Despite Prostate Cancer History

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Testosterone replacement therapy found no to increase the risk of prostate cancer progression.
Testosterone replacement therapy found no to increase the risk of prostate cancer progression.
The following article is part of conference coverage from the 2018 American Urological Association meeting in San Francisco. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2018. 

SAN FRANCISCO—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, Abraham Morgentaler, MD, Director of Men's Health Boston and Associate Clinical Professor of Urology at Harvard Medical School in Boston, and colleagues 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%.

“This is the largest series to date investigating the safety of testosterone therapy in men with prostate cancer,” Dr Morgentaler told Renal & Urology News. “Recurrence rates following prostate cancer treatment with surgery or radiation were low for men treated with testosterone, and were quite similar to expected recurrence rates based on numerous published studies. This was also true for men on active surveillance.” 

He added: “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.”

Dr Morgentaler stated that TRT can make an enormous difference in the lives of men who are testosterone-deficient. “I've had quite a few men tell me they wouldn't mind continuing with testosterone therapy even if it were certain to shorten their lives,” he related.

Eric A. Klein, MD, Chair of the Cleveland Clinic's Glickman Urological & Kidney Institute, who was not involved in the study, said the investigation by Dr Morgentaler's team “adds to the existing data that T replacement in men with early stage low-grade prostate cancer or those treated for cancer is safe and does not appear to increase the risk of progression.”

Dr Klein cautioned, however, that testosterone replacement should only be considered for men who have symptoms related to documented low testosterone levels.

Visit Renal and Urology News' conference section for continuous coverage from AUA 2018.

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.

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