RECURRENCE RATES FOLLOWING TESTOSTERONE THERAPY IN A LARGE CLINICAL COHORT OF MEN WITH PROSTATE CANCER
There is a limited evidence regarding the safety of testosterone (T) therapy (TTh) in men with a history of prostate cancer (PCa). We present here a large single-center experience of TTh in men after a variety of PCa treatments to help guide further clinical decision-making.
The electronic medical record database at a men's health center affiliated with an academic hospital was queried to identify men who received TTh for testosterone deficiency after diagnosis and/or treatment of PCa over the previous 5y. Testosterone was delivered via transdermal gels/liquids, short- and long-acting injections, and/or pellets. Biochemical recurrence (BCR) was operationally defined as PSA 0.3 ng/ml or higher after radical prostatectomy (RP), and PSA nadir plus 2 ng/ml after primary radiation treatment (external beam, brachytherapy). For men on active surveillance (AS) progression was defined as any biopsy showing higher Gleason score than initial diagnosis.
We identified 320 men with a diagnosis of both PCa and T deficiency. Of these, 222 men received TTh. We excluded from analysis men with <3 mo follow-up and men with advanced disease. Mean age for the remaining 199 men was 68y (41-88), and mean follow-up was 50.5 mo. PCa treatments included RP in 92 men, radiotherapy in 50 men, HIFU in 3 men, and active surveillance in 57 men. BCR was observed in 6 men after RP (6.5%), in 1 man after XRT (2.0%), and in 2 after HIFU. Progression was noted in 2 men on AS (3.5%). </p>
To our knowledge, this is the largest series to date of TTh in a group of men with PCa. Recurrence rates were consistent with published recurrence/progression rates for the various forms of PCa treatments and for AS. These results provide valuable and reassuring information for clinicians and patients considering TTh for symptomatic men with testosterone deficiency and a history of PCa.