madman
Super Moderator
Introduction: It has been well established that male hypogonadism has a significant impact on patient quality of life and that replacement of testosterone can markedly improve symptoms and potentially offer a protective effect. The connection between testosterone replacement therapy (TRT) and prostate cancer (CaP) risk has long been a contentious subject among urologists. With the relatively recent introduction of the saturation model hypothesis by Morgentaler to explain androgen binding in CaP along with a growing body of retrospective studies, there has been a mounting challenge to the entrenched paradigm that TRT in hypogonadal men stimulates CaP. This review is a relevant update for the practicing urologist seeking to gain a better understanding regarding the risk and benefit profile to TRT in a variety of CaP settings.
Objective: To perform a literature review and provide a clinically relevant update to characterize the relationship between TRT and risk of prostate cancer (CaP) in the following clinical settings: developing de novo prostate cancer, patients with known untreated localized CaP, after definitive therapy for CaP with curative intent, and in advanced prostate cancer. In providing this evidence-based update to the practicing urologist, we seek to potentially impact practice patterns through a more comprehensive understanding of the risks/benefits of TRT.
Methods: A literature review using the PubMed database was performed using the following independent search terms: “prostate cancer,” “testosterone therapy,” “testosterone replacement therapy,” “hypogonadism,” “radical prostatectomy,” “radiation therapy”, “advanced prostate cancer,” “metastatic castrate-resistant prostate cancer,” “bipolar androgen therapy” and “high dose testosterone therapy”. We identified English language studies and past review articles to evaluate the role of testosterone in the development of CaP, the use of TRT after CaP to treat hypogonadism, and the use of TRT as directed therapy in the advanced prostate cancer setting.
Results: The vast majority of studies reviewed were retrospective in nature with relatively short follow-up periods. TRT was found to be safe and does not appear to increase the incidence of prostate cancer de novo. In men with a history of treated or untreated CaP, TRT does not appear to increase the risk of recurrence or progression of CaP. Supraphysiologic TRT appears to show clinical benefit to mCRPC patients. Well-designed randomized studies with longer-term follow-up are lacking at present.
Conclusions: The concerns regarding TRT causing/worsening CaP appears to be unsupported by the available retrospective studies and urologists may give consideration to treating symptomatic hypogonadal men with a history of CaP. There also appears to be an emerging role for supraphysiologic TRT as a therapy in the advanced prostate cancer setting. Further well-designed randomized studies are warranted.
Objective: To perform a literature review and provide a clinically relevant update to characterize the relationship between TRT and risk of prostate cancer (CaP) in the following clinical settings: developing de novo prostate cancer, patients with known untreated localized CaP, after definitive therapy for CaP with curative intent, and in advanced prostate cancer. In providing this evidence-based update to the practicing urologist, we seek to potentially impact practice patterns through a more comprehensive understanding of the risks/benefits of TRT.
Methods: A literature review using the PubMed database was performed using the following independent search terms: “prostate cancer,” “testosterone therapy,” “testosterone replacement therapy,” “hypogonadism,” “radical prostatectomy,” “radiation therapy”, “advanced prostate cancer,” “metastatic castrate-resistant prostate cancer,” “bipolar androgen therapy” and “high dose testosterone therapy”. We identified English language studies and past review articles to evaluate the role of testosterone in the development of CaP, the use of TRT after CaP to treat hypogonadism, and the use of TRT as directed therapy in the advanced prostate cancer setting.
Results: The vast majority of studies reviewed were retrospective in nature with relatively short follow-up periods. TRT was found to be safe and does not appear to increase the incidence of prostate cancer de novo. In men with a history of treated or untreated CaP, TRT does not appear to increase the risk of recurrence or progression of CaP. Supraphysiologic TRT appears to show clinical benefit to mCRPC patients. Well-designed randomized studies with longer-term follow-up are lacking at present.
Conclusions: The concerns regarding TRT causing/worsening CaP appears to be unsupported by the available retrospective studies and urologists may give consideration to treating symptomatic hypogonadal men with a history of CaP. There also appears to be an emerging role for supraphysiologic TRT as a therapy in the advanced prostate cancer setting. Further well-designed randomized studies are warranted.
