Testosterone replacement therapy (TRT) for patients on active surveillance (AS) for localized prostate cancer is not associated with conversion to treatment, a recent study suggests.

A team led by Ahmed A. Hussein, MD, of the Roswell Park Cancer Institute in Buffalo, New York, compared 24 hypogonadal patients who received TRT while on AS to a propensity score matched cohort of 72 patients on AS who did not receive TRT.

After a median follow-up of 5.82 years, the investigators observed no significant difference in the proportion of patients who converted to treatment between the TRT and no-TRT groups (24% vs 21%), according to study findings published in Urologic Oncology. The TRT group did not experience a significant rise in PSA. The investigators also found no significant difference in treatment-free survival (TFS). PSA density was the only variable associated with TFS.

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“While the available evidence, including the current study, does not support that TRT may adversely affect the outcomes of hypogonadal men with localized [prostate cancer] on AS, close follow up of these patients is recommended,” the authors wrote. Clinicians should have a low threshold for obtaining prostate MRI scans and repeat biopsies and discontinue TRT with any evidence of disease progression, according to Dr Hussein and his team.

The authors acknowledged that the retrospective nature of their analysis is a limitation, and noted that their small sample size precludes additional analysis of the effect of individual routes of testosterone administration. Further, data about testosterone levels prior to diagnosis of prostate cancer was incomplete for some patients. Despite limitations, Dr Hussein and colleagues stated that, to their knowledge, their study involves the longest follow-up of men receiving TRT while on AS for localized prostate cancer.


Daza J, Ahmad A, Shabir U, et al. Does testosterone replacement therapy increase the risk of conversion to treatment in patients with prostate cancer on active surveillance? Urol Oncol. Published online July 7, 2023. doi:10.1016/j.urolonc.2023.06.002