Is there a protective role of testosterone against high-grade prostate cancer? Incidence and severity of prostate cancer in 553 patients undergoing prostate biopsy in a prospective data register.

Abstract

128 Background: Major concern regarding testosterone therapy (TRT) in middle-aged and elderly men is still prostate safety or cancer Methods: 553 prostate biopsies (2008-2013) were performed at our institute. 22 patients refused biopsy. We investigated incidence and severity of PCa in three groups: hypogonadal (T ≤ 350 ng/dl) men receiving TRT, hypogonadal untreated, and eugonadal men. All groups underwent similar screening intensity of at least once per year. Biopsies were performed when indicated according to EAU guidelines. Results: In 42 hypogonadal men receiving TRT, 7 (16.7%) had a positive biopsy. Of these, 5 had a Gleason score ≤ 6 (71.4%) and 2 subjects a Gleason score > 6 (28.6%). Predominant Gleason score was 3 in all 7 men (100%). Tumor grade was II in 6 (85.7%) and II-III in 1 (14.3%) men. 162 untreated hypogonadal men, 84 (51.9%) had a positive biopsy. Of these, 34 had a Gleason score ≤ 6 (40.5%) and 50 a Gleason score > 6 (59.5%). Predominant Gleason score was 3 in 65 (77.4%), 4 in 17 (20.2%) and 5 in 2 (2.4%) men. Tumor grade was II in 35 (41.7%), II-III in 10 (11.9%), III in 34 (40.5%) and IV in 5 (6.0%) men. In 349 eugonadal men, 132 (37.8%) had a positive biopsy. Of these, 56 had a Gleason score ≤ 6 (42.4%) and 76 a Gleason score > 6 (57.6%). Predominant Gleason score was 3 in 109 (82.6%), 4 in 22 (16.7%) and 5 in 1 (0.1%) men. Tumor grade was II in 59 (44.7%), II-III in 6 (4.5%), III in 63 (47.7%) and IV in 4 (3.0%) men. Conclusions: The incidence of positive prostate biopsies was lowest in hypogonadal men receiving TRT. The severity of PCa – in terms of Staging and Grading - was significantly lower in hypogonadal patients receiving TRT. TRT may protect against high-grade PCa. Protective role of TRT against PCa must be discussed and considered in larger studies.