madman
Super Moderator
* For clinicians considering TTh in men after prostate cancer treatment, several considerations should guide decision-making. Patient selection is critical with regular monitoring, with close attention to PSA velocity and testosterone levels. The benefits of treating hypogonadism, including improvements in energy, sexual function, bone density, body composition, and potentially cardiovascular health, must be weighed against the theoretical risk of promoting occult cancer cells in each individual patient. The current literature suggests that TTh can be safely administered to carefully selected men after definitive treatment for localized prostate cancer with the evidence being stronger for postprostatectomy patients. While larger prospective studies with longer follow-up would further strengthen these conclusions, the available data challenge the historical contraindication of TTh in this population.
auanews.net
For decades, testosterone therapy (TTh) was considered contraindicated for men with a history of prostate cancer. This belief came from the seminal work of Huggins and colleagues in the 1940s, which demonstrated that castration led to prostate cancer regression.1 However, more recent evidence has challenged this idea, suggesting that TTh may be a viable option for carefully selected patients.
The “dogma” that prescribing TTh to men with a history of prostate cancer would inevitably lead to disease recurrence led to numerous men with hypogonadism being denied treatment that could have improved their quality of life. The saturation model, proposed by Morgentaler and colleagues, offered an alternative framework, suggesting that prostate cancer cells respond to testosterone only at very low concentrations.2 Once the androgen receptors in prostatic tissue become saturated at these relatively low testosterone levels, additional testosterone does not accelerate cancer growth. This new model encouraged researchers to reevaluate the risks of TTh in this patient population. Additionally, newer studies have demonstrated that TTh does not appear to increase prostate cancer incidence in men without a previous cancer diagnosis.
One recent retrospective study with 5199 men examined the safety of TTh in men who have undergone radical prostatectomy for localized prostate cancer.3 They found no evidence that administration of TTh after radical prostatectomy causes biochemical recurrence (BCR) with a nonsignificant decreased risk of BCR associated with TTh (HR, 0.84; 95% CI, 0.48-1.46). Also, the overall rates of BCR were low, with probability at 5 years less than 2% in both TTh and non-TTh groups. These findings also align with earlier studies that also found TTh effective in improving testosterone levels without increasing PSA values in hypogonadal men post prostatectomy.4 Similarly, Pastuszak et al reviewed 103 hypogonadal men with prostate cancer treated with TTh after prostatectomy compared with 49 nonhypogonadal reference patients, finding only 4 cases of cancer recurrence in the treatment group vs 8 in the reference group despite a significant increase in testosterone levels.5Finally, a large cohort analysis using the national US Veterans Affairs database, which identified 69,984 patients with localized prostate cancer diagnosed from 2001 to 2015 treated with surgery or radiation, found that TTh did not increase the risks of BCR, prostate cancer–specific mortality, or overall mortality after definitive treatment.6
Another recent study by Applewhite et al explored the impact of TTh in men undergoing active surveillance (AS) for low-risk prostate cancer.7 This retrospective analysis of 43 men found no significant changes in PSA levels after TTh initiation (P = .87), and biopsy progression rates remained comparable with the general AS population. Among the 15 men who underwent repeat biopsies, 80% showed no progression, and only 3 developed Gleason 7 disease after an extended follow-up (mean: 79.5 months). None developed metastatic disease. These findings suggest that TTh may be safely administered in well-selected AS patients without significantly increasing the risk of disease progression.
For clinicians considering TTh in men after prostate cancer treatment, several considerations should guide decision-making. Patient selection is critical with regular monitoring, with close attention to PSA velocity and testosterone levels. The benefits of treating hypogonadism, including improvements in energy, sexual function, bone density, body composition, and potentially cardiovascular health, must be weighed against the theoretical risk of promoting occult cancer cells in each individual patient. The current literature suggests that TTh can be safely administered to carefully selected men after definitive treatment for localized prostate cancer with the evidence being stronger for postprostatectomy patients. While larger prospective studies with longer follow-up would further strengthen these conclusions, the available data challenge the historical contraindication of TTh in this population. Clinicians should approach each case individually, implementing careful monitoring protocols and maintaining open communication about the current state of evidence. As our understanding continues to evolve, it appears that many men previously denied testosterone replacement due to a history of prostate cancer may safely benefit from this therapy without compromising their oncologic outcome.
Testosterone Supplementation After Localized Prostate Cancer: The Current State of the Literature - American Urological Association
For decades, testosterone therapy (TTh) was considered contraindicated for men with a history of prostate cancer. This belief came from the seminal work of Huggins and colleagues in the 1940s, which demonstrated that castration led to prostate cancer regression. However, more recent evidence has...
auanews.net
For decades, testosterone therapy (TTh) was considered contraindicated for men with a history of prostate cancer. This belief came from the seminal work of Huggins and colleagues in the 1940s, which demonstrated that castration led to prostate cancer regression.1 However, more recent evidence has challenged this idea, suggesting that TTh may be a viable option for carefully selected patients.
The “dogma” that prescribing TTh to men with a history of prostate cancer would inevitably lead to disease recurrence led to numerous men with hypogonadism being denied treatment that could have improved their quality of life. The saturation model, proposed by Morgentaler and colleagues, offered an alternative framework, suggesting that prostate cancer cells respond to testosterone only at very low concentrations.2 Once the androgen receptors in prostatic tissue become saturated at these relatively low testosterone levels, additional testosterone does not accelerate cancer growth. This new model encouraged researchers to reevaluate the risks of TTh in this patient population. Additionally, newer studies have demonstrated that TTh does not appear to increase prostate cancer incidence in men without a previous cancer diagnosis.
One recent retrospective study with 5199 men examined the safety of TTh in men who have undergone radical prostatectomy for localized prostate cancer.3 They found no evidence that administration of TTh after radical prostatectomy causes biochemical recurrence (BCR) with a nonsignificant decreased risk of BCR associated with TTh (HR, 0.84; 95% CI, 0.48-1.46). Also, the overall rates of BCR were low, with probability at 5 years less than 2% in both TTh and non-TTh groups. These findings also align with earlier studies that also found TTh effective in improving testosterone levels without increasing PSA values in hypogonadal men post prostatectomy.4 Similarly, Pastuszak et al reviewed 103 hypogonadal men with prostate cancer treated with TTh after prostatectomy compared with 49 nonhypogonadal reference patients, finding only 4 cases of cancer recurrence in the treatment group vs 8 in the reference group despite a significant increase in testosterone levels.5Finally, a large cohort analysis using the national US Veterans Affairs database, which identified 69,984 patients with localized prostate cancer diagnosed from 2001 to 2015 treated with surgery or radiation, found that TTh did not increase the risks of BCR, prostate cancer–specific mortality, or overall mortality after definitive treatment.6
Another recent study by Applewhite et al explored the impact of TTh in men undergoing active surveillance (AS) for low-risk prostate cancer.7 This retrospective analysis of 43 men found no significant changes in PSA levels after TTh initiation (P = .87), and biopsy progression rates remained comparable with the general AS population. Among the 15 men who underwent repeat biopsies, 80% showed no progression, and only 3 developed Gleason 7 disease after an extended follow-up (mean: 79.5 months). None developed metastatic disease. These findings suggest that TTh may be safely administered in well-selected AS patients without significantly increasing the risk of disease progression.
For clinicians considering TTh in men after prostate cancer treatment, several considerations should guide decision-making. Patient selection is critical with regular monitoring, with close attention to PSA velocity and testosterone levels. The benefits of treating hypogonadism, including improvements in energy, sexual function, bone density, body composition, and potentially cardiovascular health, must be weighed against the theoretical risk of promoting occult cancer cells in each individual patient. The current literature suggests that TTh can be safely administered to carefully selected men after definitive treatment for localized prostate cancer with the evidence being stronger for postprostatectomy patients. While larger prospective studies with longer follow-up would further strengthen these conclusions, the available data challenge the historical contraindication of TTh in this population. Clinicians should approach each case individually, implementing careful monitoring protocols and maintaining open communication about the current state of evidence. As our understanding continues to evolve, it appears that many men previously denied testosterone replacement due to a history of prostate cancer may safely benefit from this therapy without compromising their oncologic outcome.
