Incidence of Prostate Cancer in Men on Testosterone Replacement Therapy after Resection of Pituitary Adenomas: No Increased Risk on Long-Term Follow-Up

Abstract

Despite evidence to the contrary, concern exists regarding prostate cancer (PCa) in men managed with long-term testosterone replacement therapy (TRT). After pituitary resection, many men develop hypogonadism requiring replacement. We sought to determine the incidence of PCa diagnosed subsequent to TRT in men with long-term follow-up after pituitary surgery. Since 2000, all patients undergoing resection of pituitary adenoma have been entered into a prospective database. Cases from 2000 to 2016 were reviewed for demographics and clinical parameters. Male patients were categorized by receipt of TRT. One hundred twenty-two cases were identified. Nine men diagnosed with PCa prior to pituitary surgery were excluded. Of the remainder, 56 (49.6%) received TRT, and 57 (50.4%) did not (control group). There were no significant demographic differences between groups. Mean preoperative and postoperative testosterone values were 253 and 131, respectively (p = 0.013). Mean preoperative and postoperative prostate specific antigens (PSA) were 0.5 and 0.57, respectively (NS). Mean duration of TRT was 5 years, and mean follow-up was 11 years. After TRT, mean testosterone and PSA were 385 and 0.84, respectively (p = 0.00003 and NS). One patient was diagnosed with PCa subsequent to TRT and no cases were found among controls (NS). For the case identified, timing of diagnosis was felt to be too proximate to initiation of TRT to be attributable. This study is the first to examine rates of PCa among men treated with TRT for hypogonadism secondary to pituitary resection. This analysis suggests that TRT is not associated with an increased risk of PCa in this population.