Is Testosterone Therapy Safe in Patients with Treated and Untreated Prostate Cancer?

MedicalResearch.com Interview with:

Dr. Jesse Ory Department of Urology, Faculty of Medicine Dalhousie University, Halifax Nova Scotia, Canada

Dr. Jesse Ory

Dr. Jesse Ory
Department of Urology, Faculty of Medicine
Dalhousie University, Halifax
Nova Scotia, Canada 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The use of Testosterone Therapy (TT) in men diagnosed with and treated for prostate cancer (CaP) has been highly controversial for several decades. Unfortunately, this controversy is largely founded on the results of a single patient in a study by Huggins and Hodges in the 1940s [1]. This wasn’t challenged until recently, when Morgentaler reviewed the literature on the topic and found no scientific basis for the assumption that TT will act like fuel on the fire of prostate cancer [2]. He also proposed a mechanism, the “saturation hypothesis” that helps account for why TT may in fact be safe for men with prostate cancer. [3]. Over the past decade, retrospective evidence has been accumulating that supports the safety of Testosterone Therapy in hypogonadal men with CaP on Active Surveillance, or in those who have been definitively treated for prostate cancer..

MedicalResearch.com: What are the main findings?

Response:

In our study, we retrospectively looked at data from 82 men, all who had received TT after a diagnosis, and in most cases treatment, for  prostate cancer.. The summary of the important findings are as follows:

Of the 82 men analyzed:

– 50 were treated with radiation therapy (37 with external beam radiotherapy, 13 with brachytherapy).
– 22 were treated with radical prostatectomy (RP)
– 8 were followed with active surveillance (AS)
– 21 of these men received neoadjuvant androgen deprivation therapy.

The median age of the men was 75.5 years.
The median follow up while on TT was 41 months.

When comparing PSA and testosterone in the entire cohort before and after TT initiation:
– serum testosterone showed a significant increase in all groups (p<0.001)
– serum PSA showed a significant increase in all groups, and within each treatment group.

Of the 22 men treated with radical prostatectomy, there were no incidences of biochemical recurrence (BCR).
-Of the 50 men treated with radiation therapy, there were 3 instances (6%) of BCR. 1 of these men experienced clinical progression.

Of the 8 men treated with active surveillance:

– all patients had low volume Gleason 6 disease.

– no patients were upgraded to higher Gleason score on repeat biopsy.

Analyzing background literature shows that our rate of BCR is lower than what is reported in large trials of radiation therapy [4] and radical prostatectomy [5]; albeit our follow up isn’t as long as those studies.

MedicalResearch.com: What should readers take away from your report?

Response: In hypogonadal men with a history of treated or untreated prostate cancer, testosterone therapy resulted in an increase in testosterone and a small but significant increase in PSA. These findings are similar to what is seen in other, similar studies. In all men with treated and untreated prostate cancer, there is a baseline rate of progression and/or biochemical recurrence. While our rates are lower than what is published in the literature, our trial design does not allow for comment on causative, or preventative factors.

It is important to note that to answer this question definitively, the urologic community needs randomized, placebo controlled trials. In the absence of these, our study supports the hypothesis that testosterone therapy may be oncologically safe in hypogonadal men after definitive treatment or in those on active surveillance for prostate cancer.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: To make confident clinical recommendations to hypogonadal men with treated or surveilled prostate cancer, we need high quality randomized, placebo controlled trials. Until then, the use of testosterone therapy in this population needs to be done on a case-by-case basis, after a thorough discussion of the risks and benefits prior to initiating treatment.

MedicalResearch.com: Is there anything else you would like to add?

Response: This is a very exciting time in urology research. As old axioms are being slowly challenged, I expect that the way we treat hypogonadal patients with a history of prostate cancer will dramatically change over the next 5-10 years.

  1. Huggins C and Hodges CV: The effect of castration, of estrogen and of androgen injection on serum phosphatase on metastatic carcinoma of the prostate. Cancer Res 1941; 1: 293
  1. Morgentaler A: Testosterone and prostate cancer: an historical perspective on a modern myth. Eur Urol 2006; 50: 935.
  1. Morgentaler A and Traish AM: Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgendependent growth. Eur Urol 2009; 55: 310.
  1. Zumsteg ZS, Spratt DE, Romesser PB et al: The natural history and predictors of outcome following biochemical relapse in the dose escalation era for prostate cancer patients undergoing definitive external beam radiotherapy. Eur Urol 2015; 67: 1009.
  1. Pastuszak AW, Pearlman AM, Lai WS et al: Testosterone replacement therapy in patients with prostate cancer after radical prostatectomy. J Urol 2013; 190: 639.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Testosterone Therapy in Patients with Treated and Untreated Prostate Cancer: Impact on Oncologic Outcomes
Ory, Jesse et al.
The Journal of Urology , Volume 196 , Issue 4 , 1082 – 1089

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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