Testosterone Therapy in Men on Active Surveillance

Abstract

In recent decades, although prostate cancer (PCa) mortality has dramatically decreased, addressing the quality of life for PCa survivors has become an area of great interest. This is especially important among men who are enrolled in active surveillance (AS) to manage their PCa. Since men with PCa are likely to experience erectile dysfunction, decreased libido, and loss of lean muscle mass secondary to testosterone deficiency (TD) as a consequence of antitumor therapies or advanced age, testosterone therapy (TTh) is typically the indicated treatment to alleviate the symptoms of TD. However, due to the theoretical causal relationship of increased testosterone levels leading to PCa development, the usage of TTh in men who have been diagnosed with PCa has long been the subject of debate. As there is an increased number of men with PCa who are enrolling in AS for the management of PCa, there needs to be an evaluation of the safety and efficacy of TTh in this cohort. Recently, the previous relationship between TTh and PCa has been challenged, and emerging evidence suggests that TTh may not be directly associated with PCa development or progression. Instead, TTh usage may safely improve the quality of life for those men on AS. This review summarizes and analyzes the latest findings on the use of TTh in men on AS for PCa.