Testosterone replacement in hypogonadal prostate cancer patients

There continues to be controversy over the role of testosterone replacement therapy (TRT) in men with prostate cancer who are “hypogonadal” — i.e., men with very low testosterone levels — as a consequence of their treatment.

Leibowitz et al. have reviewed the records of 96 patients who received TRT after initial management for prostate cancer between 2000 and 2007 in an attempt to describe the clinical outcomes of TRT in these prostate cancer survivors.

Their results can be summarized as follows:

  • 41/96 men had PSA progression (as defined by the PSA Working Group) while on TRT, but only 7/96 had radiographic progression of disease.
  • 56/96 men discontinued TRT due to increasing PSA levels, and 59 percent of these men had significant reductions in PSA level with no additional intervention.
  • 31/96 men currently remain on TRT with no PSA or radiological progression at a median of 36.7 months.
  • 9/96 men stopped TRT for reasons other than progression.
  • Characteristics associated with continuing TRT were radical prostatectomy as primary management, a low PSA level when starting TRT, and concurrent use of dutasteride.
  • Hypogonadal symptoms were alleviated in most cases.

The authors conclude that, “While most men in this series had increasing PSA levels during TRT, stopping TRT typically resulted in PSA declines. A subset of men were able to remain on TRT for several years without disease progression.”

It seems likely to The “New” Prostate Cancer InfoLink that this report gives us a very good picture of the outcomes of TRT in the “real world.” Some patients are able to handle it, and others have an early biochemical recurrence of their cancer in response to TRT.

The question is going to be whether we can get better at identifying the men who are able to receive TRT with minimal risk of PSA recurrence.

One Response

  1. The article is informative seeing that I am a cancer survivor. Presently my PSA is 0.032 and I have a low testosterone reading. Underwent ADT for over 15 months. I am 74 years old and still sexually active but with some difficulty. Hoping that TRT could apply to me.

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