The use of TRT in hypogonadal prostate cancer patients

We may be seeing the beginning of a real turning point in opinions about the role of testosterone replacement therapy (TRT) in men who have been treated for prostate cancer. … Well, at least among selected men who have well-documented, hypogonadal (below normal) levels of serum testosterone (serum T).

In an editorial in the November issue of the Journal of Urology, Carson and Kirby, two leading authorities on the management of prostate cancer (from the USA and the UK respectively) have provided commentary on this controversial topic in which they conclude that:

While more data are needed, health care providers can begin to consider treating hypogonadal patients who have prostate cancer with TRT if they are symptomatic, have documented low testosterone and are properly informed.

Unfortunately the full text of this article is only available to subscribers to the Journal of Urology (unless you want to pay for a copy).

That is a very serious re-statement about the potential role of TRT in the management of men with prostate cancer by two members of the editorial board in one of the world’s premier urology journals when we consider where this discussion all started.

So which patients are we actually talking about here?

The Carson-Kirby editorial is actually not overly specific about this. However, what they appear to be saying is that TRT may be appropriate for hypogonadal men who meet one of the following three sets of criteria:

  • Patients who have been treated successfully by radical prostatectomy for localized prostate cancer and have low PSA levels but also low serum T levels post-treatment
  • Patients who have been treated successfully by external beam radiation therapy or brachytherapy for localized prostate cancer and have low PSA levels but also low serum T levels post-treatment
  • Patients who have been diagnosed with prostate cancer, are on active surveillance, but have stable PSA levels and low serum T levels

What is much less clear (and Carson and Kirby do not address or comment on this issue) is whether it is safe to give TRT to men who are hypogonadal as a direct consequence of androgen deprivation therapy. We know that this has been done in some cases, but (at least as yet) the evidence is less compelling about the safety of TRT in such men.

The proviso that Carson and Kirby add in their editorial comments is that close monitoring (they use the word “vigilant”) of all such patients who are receiving TRT after a diagnosis of and/or treatment for prostate cancer remains an imperative, and they imply that any associated rise in a patient’s PSA level is a potential warning sign for a real problem.

3 Responses

  1. Glad to see everyone catching up. :-)

  2. Abraham Morgentaler, MD, FACS (founder of “Men’s Health Boston – A medical practice catering to patients with low T levels) has advocated for sometime that testosterone replacement therapy is safe for prostate cancer patients-even those with active disease. In fact he wrote a book in which he addresses this very topic.

    And another forward-looking a.k.a. renegade doctor, Dr. Bob Leibowitz, in Los Angeles (Lebowitz was one of the first doctors who advocated using triple androgen deprivation therapy as a primary treatment for prostate cancer), has found that treating some of his patients with very high levels of testosterone has actually resulted in dimunation of active disease (and his patients feel terrific).

  3. Exactly.

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