Uro‐oncologists practicing in the United Kingdom do not routinely measure testosterone in prostate cancer (PCa) patients receiving androgen deprivation therapy (ADT), according to new study findings published in the International Journal of Clinical Practice. Specialists also “remain cautious” about prescribing testosterone replacement therapy (TRT) in this population.

The British Uro‐oncology Group (BUG) invited uro‐oncologists to complete a questionnaire on PCa care. Of the 84 respondents, only 45% measured testosterone levels before starting ADT in patients with non‐metastatic PCa. Sixty-one percent did not measure testosterone in these patients during ADT in either the adjuvant or neoadjuvant setting. Half of the specialists failed to measure testosterone once ADT had been stopped.

Men with metastatic PCa were monitored more closely. Nearly three-quarters (71%) of uro‐oncologists measured testosterone prior to ADT initiation, and most continued testing during treatment. More than half tested in the event of rising PSA, biochemical failure, progression, inadequate response to ADT, management changes, and castration status. About 70% of respondents measured testosterone levels once the patient had progressed to castration‐resistant PCa.

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TRT use was uncommon. Two‐thirds of uro-oncologists had not prescribed TRT for patients in remission following neoadjuvant or adjuvant ADT who had castration levels of testosterone. When asked about starting TRT prescription, the uro‐oncologists mostly recommended initiation at 2 years after ADT cessation. More than half of specialists who previously did not prescribe TRT would consider it in the future, but 36% would not. Once a patient started on TRT, 58% of the uro‐oncologists would monitor testosterone levels every 3 months.

“Specialists remain cautious about the possible benefits of TRT in men with prostate cancer, even though recent studies to date indicate no increased risk of recurrence. Clear guidance is needed for the use of TRT in these patients,” lead author Heather Payne, MBBS, of the University College London Hospitals, and colleagues stated.

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Payne H, McMenemin R, Bahl A, Greene D, and Staffurth J. Measuring testosterone and testosterone replacement therapy in men receiving androgen deprivation therapy for prostate cancer: A survey of UK uro‐oncologists’ opinions and practice. Int J Clin Pract. 2018;e13292. DOI:10.1111/ijcp.13292