Abstract
Since the 1940s, elevated serum testosterone (T) levels have been infamously suggested as a causal factor in the development of prostate cancer (PCa); this time was also the dawn of both surgically and pharmacologically induced castration. However, men suffering from primary or secondary hypogonadism and who are concomitantly paradoxically at risk for developing PCa cited the adverse effects of T deficiency. In the past 25 years, researchers have published on the genetic, biochemical, and clinical outcomes of testosterone replacement therapy (TRT) in hypogonadal men. The longstanding dogma of the deleterious effects of TRT has recently been challenged, and it now appears that TRT may have an important therapeutic role in the treatment of hypogonadism in those men with either low-risk, active, or previously treated PCa. This review summarizes the latest findings on the treatment of hypogonadal men with a history of PCa, emphasizing results of clinical research studies.
Highlights
Prostate cancer (PCa) is the most common cancer in men in the United States, with *192,000 new cases in 2020.1 This number of annual cases is expected to rise as the population ages
Biochemical recurrence (BCR) of prostate cancer (PCa) has been cited at a rate of 13– 53% in patients after radiation therapy6 and at 30.2% 3 years post–radical prostatectomy (RP)
It is estimated that up to 30% of males between 40 and 79 years of age are hypogonadal and 39% of males between the ages of 45–85 have a testosterone (T) level
Summary
Prostate cancer (PCa) is the most common cancer in men in the United States, with *192,000 new cases in 2020.1 This number of annual cases is expected to rise as the population ages. The use of TRT in that population did not result in increased risk of PCa (hazard ratio [HR] = 0.97 [95% confidence interval; CI 0.71–1.32) in an overall analysis, nor when propensity score matching was applied (HR = 0.87, 95% CI 0.56–1.36).27 In another longer-term study of T therapy in 1023 hypogonadal men, with a mean follow-up of 5 years, there were 11 cases of PCa (1.08%)—a prevalence figure lower than that reported by two large screening studies— the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial (7.35%) and the European Randomized Study of Screening for PCa (ERSPC) (9.6%).
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