Testosterone therapy in hypogonadal prostate cancer patients who have had definitive treatment and in those on active surveillance appears to be safe, according to a new study.
Urologists and others have been cautious about using testosterone therapy in men with prostate cancer since the early 1940s, when Huggins et al published research suggesting reductions in testosterone caused metastatic prostate cancer to regress, while exogenous testosterone administration caused the cancer to grow (Arch Surg 1941; 43:209-23). But studies in the last 20 years, including a historical perspective by Abraham Morgentaler, MD, published in 2006, suggest the association is a myth and there is no scientific basis for thinking testosterone causes prostate cancer to grow (Eur Urol 2006; 50:935-9).
In this new study, published in the Journal of Urology (2016; 196:1082-9), Canadian and Australian researchers found similar results. They studied 82 hypogonadal prostate cancer patients treated with testosterone therapy. Among the subjects, 50 men had received radiation therapy, 22 had radical prostatectomy, eight were on active surveillance, one had cryotherapy, and one was treated with high-intensity focused ultrasound.
In a median 41-month follow-up, they found increases in testosterone and PSA levels among all the prostate cancer patients on testosterone therapy. PSA increased among active surveillance patients, but none were upgraded to higher Gleason scores, nor had they progressed to definitive treatment. While none of the radical prostatectomy patients experienced biochemical recurrence, three of the radiotherapy patients did. Whether those cases of biochemical recurrence resulted from testosterone therapy or the natural disease course is unclear, the authors write.
The authors report PSA velocity was 0.001 ug/L/yr in the radical prostatectomy group, 0.12 ug/L/yr in the radiotherapy group, and 1.1 ug/L/yr among those on active surveillance.