madman
Super Moderator
Abstract
Background Although prostate cancer (PCa) screening is conducted before testosterone replacement therapy (TRT), clinically occult PCa cases may exist.
Methods To evaluate whether the possible inclusion of occult PCa cases distorts the effect of TRT on risk of PCa, we followed 776 hypogonadal males (TRT = 400, non-TRT = 376) from a urology center in Germany from 2004 to 2016, with a mean follow-up period of 7 years. We assumed occult cases might take 1–2 years (latency period) to become clinically detectable after receiving TRT. We selected several latency periods (12/18/24 months) and compared the risk of PCa in the TRT and non-TRT group over the latency period, from the end of latency period till the end of follow-up, and over the whole follow-up time.
Results Overall, 26 PCa cases occurred in the non-TRT group vs 9 cases in the TRT group. Within 18 months of follow-up, 9 cases occurred in the TRT group vs 0 cases in the non-TRT group; from the end of 18 months till the end of follow-up, 26 cases occurred in the non-TRT group vs 0 cases in the TRT group. The adjusted table showed seemingly adverse effects of TRT on PCa development within 18 months (p = 0.0301) and beneficial effects from the end of 18 months till the end of follow-up (p = 0.0069). Similar patterns were observed for 12 or 24 months as the latency period.
Conclusions TRT may make occult PCa cases detectable within early phase of treatment and present a beneficial effect in the long run. Future longitudinal studies are needed to confirm findings from our exploratory analyses.
Conclusions
It is important to recognize that inclusion of potential occult PCa cases may distort the effects of TRT on risk of PCa. PSA test without concurrent testing of T levels may limit the use of PSA test in cancer diagnosis, especially among men with depressed T levels. PCa screening should not be neglected in hypogonadal men; T measurements at regular intervals should become part of the routine examination in middle-aged and elderly men. Without knowing the presence of clinically occult PCa cases, the patient should be adequately counseled for possible consequences following TRT. PCa screening at early stage (12–24 months) of treatment is crucial; improved screening techniques are needed to detect early-stage PCa during “latency period”. Last but not least, future formal studies are required to confirm the hypothesis generated from this study.
Background Although prostate cancer (PCa) screening is conducted before testosterone replacement therapy (TRT), clinically occult PCa cases may exist.
Methods To evaluate whether the possible inclusion of occult PCa cases distorts the effect of TRT on risk of PCa, we followed 776 hypogonadal males (TRT = 400, non-TRT = 376) from a urology center in Germany from 2004 to 2016, with a mean follow-up period of 7 years. We assumed occult cases might take 1–2 years (latency period) to become clinically detectable after receiving TRT. We selected several latency periods (12/18/24 months) and compared the risk of PCa in the TRT and non-TRT group over the latency period, from the end of latency period till the end of follow-up, and over the whole follow-up time.
Results Overall, 26 PCa cases occurred in the non-TRT group vs 9 cases in the TRT group. Within 18 months of follow-up, 9 cases occurred in the TRT group vs 0 cases in the non-TRT group; from the end of 18 months till the end of follow-up, 26 cases occurred in the non-TRT group vs 0 cases in the TRT group. The adjusted table showed seemingly adverse effects of TRT on PCa development within 18 months (p = 0.0301) and beneficial effects from the end of 18 months till the end of follow-up (p = 0.0069). Similar patterns were observed for 12 or 24 months as the latency period.
Conclusions TRT may make occult PCa cases detectable within early phase of treatment and present a beneficial effect in the long run. Future longitudinal studies are needed to confirm findings from our exploratory analyses.
Conclusions
It is important to recognize that inclusion of potential occult PCa cases may distort the effects of TRT on risk of PCa. PSA test without concurrent testing of T levels may limit the use of PSA test in cancer diagnosis, especially among men with depressed T levels. PCa screening should not be neglected in hypogonadal men; T measurements at regular intervals should become part of the routine examination in middle-aged and elderly men. Without knowing the presence of clinically occult PCa cases, the patient should be adequately counseled for possible consequences following TRT. PCa screening at early stage (12–24 months) of treatment is crucial; improved screening techniques are needed to detect early-stage PCa during “latency period”. Last but not least, future formal studies are required to confirm the hypothesis generated from this study.
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