From the Guidelines
Testosterone injections are not recommended for men who have had prostate cancer, unless they have been cured and are experiencing severe hypogonadism symptoms, in which case carefully monitored testosterone therapy may be considered. This is because testosterone can potentially stimulate the growth of any remaining prostate cancer cells, which could lead to cancer recurrence or progression, as noted in studies such as 1. Most doctors advise against testosterone replacement therapy (TRT) for at least 3-5 years after successful prostate cancer treatment, and some recommend avoiding it indefinitely. However, some specialists might consider carefully monitored testosterone therapy in specific cases where men are experiencing severe hypogonadism symptoms (like fatigue, decreased libido, depression) and have had low-risk prostate cancer that was successfully treated with no evidence of recurrence for several years.
Key Considerations
- The decision to use testosterone therapy after prostate cancer should involve consultation with both a urologist and endocrinologist who can evaluate individual risk factors and monitor treatment closely, as recommended in 1.
- Regular PSA monitoring (every 3-6 months) is necessary to quickly identify any potential issues, and immediate discontinuation of testosterone therapy is required if PSA levels rise, as suggested in 1.
- The biological concern is that prostate cancer cells often have androgen receptors that respond to testosterone, potentially triggering growth, which is a key consideration in the decision to use testosterone therapy after prostate cancer, as discussed in 1.
Monitoring and Treatment
- Monitoring for signs of prostate cancer is mandatory, given the widespread concern that testosterone treatment may stimulate the growth of an occult cancer, as noted in 1.
- Men who present with an abnormal result on digital rectal examination or elevated PSA level should have a documented negative result from a prostate biopsy before testosterone-replacement therapy is initiated, as recommended in 1.
- There are different approaches to monitoring for prostate cancer in men with normal digital rectal examinations and PSA levels, including reserving prostate biopsy for those who have an abnormal digital rectal examination or a PSA level above 4.0 ng per milliliter during the course of treatment, as discussed in 1.
From the FDA Drug Label
Geriatric patients treated with androgens may be at an increased risk for the development of prostatic hypertrophy and prostatic carcinoma
The use of testosterone injections after prostate cancer is not directly addressed in the provided drug labels. Testosterone therapy may increase the risk of prostatic hypertrophy and prostatic carcinoma in geriatric patients, but there is no explicit information on the safety of testosterone injections in patients with a history of prostate cancer 2, 2.
From the Research
Testosterone Injections After Prostate Cancer
- The use of testosterone replacement therapy (TRT) in men with a history of prostate cancer has been a topic of debate, with some concerns that it may increase the risk of cancer recurrence 3.
- However, studies have shown that TRT does not pose a significant risk of prostate cancer growth in men with or without prior treatment, and that the cancer rate in TRT trials is similar to detection rates in screening programs 3.
- In fact, some studies have reported no prostate-specific antigen (PSA) recurrence with TRT in small numbers of men who had undetectable PSA values after radical prostatectomy, suggesting that TRT may be safe for men who appear cured of their disease 3.
- Monitoring with PSA and digital rectal examination at regular intervals is still recommended for men undergoing TRT after prostate cancer treatment 3.
Screening for Prostate Cancer
- Prostate-specific antigen (PSA) testing is a common method for screening for prostate cancer, and can detect tumors at an early stage 4, 5, 6.
- Digital rectal examination (DRE) is also used as a screening tool, but its diagnostic value is limited, and it may not be necessary to conduct this examination routinely 7.
- The combination of PSA and DRE may improve the detection of prostate cancer, but the benefits of this approach are still being debated 4, 5, 7.
- Active surveillance is increasingly accepted as the preferred standard of care for patients with newly diagnosed low-risk prostate cancer, as it is associated with similar long-term survival and better quality of life than curative treatment 6.