Testosterone therapy appears to be safe for hypogonadal, or testosterone deficient, men with prostate cancer, according to the results of a study conducted at the University of British Columbia in Vancouver, Canada.
The study, “Testosterone Therapy in Patients with Treated and Untreated Prostate Cancer: Impact on Oncologic Outcomes,” published in The Journal of Urology, shows that testosterone therapy does not increase the cancer’s aggressiveness in these men.
Late-onset male hypogonadism occurs in about 3.1 percent to 7 percent of men younger than age 70, and 18.4 percent of men older than 70 years. It is characterized by low levels of testosterone and a constellation of symptoms and physical changes that increase with the degree of deficiency.
With earlier detection and improved survival from early stage prostate cancer, it is likely that the numbers of men presenting with hypogonadal symptoms following curative surgery0 will increase.
Testosterone therapy (TT), which typically involves the administration of testosterone through injections, skin creams, patches, gels, or subcutaneous pellets, has been proven effective in improving symptoms of hypogonadism. But due to claims that testosterone may increase prostate cancer growth, this therapy has been approached with caution in patients.
In this study, researchers examined the effects of testosterone therapy in a cohort of people either treated for prostate cancer or on active surveillance for a low-risk cancer.
Examining electronic medical records at the Vancouver Prostate Center at Vancouver General Hospital and the Victoria General Hospital, they identified 82 hypogonadal men (median age, 75.5 years) with prostate cancer who were treated with TT (transdermal, intramuscular, oral or mixed). The group included 50 men who had been treated with radiation therapy, 22 treated with radical prostatectomy, one patient given cryotherapy, and one who underwent high intensity focused ultrasound. Eight patients were on active surveillance.
In all patients, prostate-specific antigen (PSA) levels were measured before TT initiation, and compared to those obtained at the last follow-up (median of 41 months after TT). Elevated PSA levels may indicate prostate cancer. According to the National Cancer Institute, PSA levels under 4 ng/mL is the cutoff for concern about the risk of prostate cancer.
Overall, the researchers found that PSA was significantly increased after testosterone therapy, with those patient who underwent radical prostatectomy and radiotherapy, or are on active surveillance showing significant increases in their PSA levels. The route of testosterone delivery did not influence the increase in PSA levels.
Although men on active surveillance had an increase in PSA, these patients did not upgrade in Gleason scores, a scale that grades prostate cancers based on prostate biopsies, and none had started definitive prostate cancer treatment.
The researchers found no biochemical recurrence — which was determined as PSA levels greater than 0.2 μg/l — among patients treated with radical prostatectomy, but three patients (6 percent) who received radiation therapy did have biochemical recurrence. However, the researchers said that it was unclear whether these cases were related to testosterone therapy.
“In the absence of randomized, placebo controlled trials, 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,” the authors wrote.