Can you take testosterone replacement therapy (TRT) after a prostatectomy?

From the Guidelines

Testosterone replacement therapy (TRT) can be considered in men who have undergone radical prostatectomy with favorable pathology and undetectable PSA postoperatively. When considering TRT after prostatectomy, it's essential to evaluate the individual's overall health and cancer status, as noted in the 2018 AUA guideline 1. Key factors to consider include:

• Negative margins, negative seminal vesicles, and negative lymph nodes
• Undetectable PSA levels after surgery
• Limited data suggesting no significant increase in prostate cancer recurrence with TRT, although high-risk groups may experience an increase in PSA
• The need for careful patient selection and regular monitoring

Typically, doctors prefer to wait at least 6-12 months after surgery to ensure PSA remains undetectable before starting TRT. Common TRT options include:

• Testosterone injections (such as testosterone cypionate 50-200mg every 1-2 weeks)
• Transdermal gels (like AndroGel 1% applied daily)
• Pellets implanted subcutaneously every 3-6 months Regular monitoring is crucial while on TRT, including:
• PSA tests every 3-6 months
• Testosterone levels to ensure they remain within normal range (typically 350-1000 ng/dL) As noted in the 2018 AUA guideline 1, the decision to start TRT after prostatectomy should be made on an individual basis after careful discussion with your urologist or oncologist.

From the Research

Testosterone Replacement Therapy After Prostatectomy

• Testosterone replacement therapy (TRT) can be considered for men with symptomatic testosterone deficiency after prostatectomy, as studies suggest it may be safe and effective in correcting symptoms of testosterone deficiency 2, 3, 4, 5.
• A randomized controlled trial found that TRT did not increase prostate-specific antigen (PSA) levels or clinical recurrence in men with non-aggressive prostate cancer who had undergone prostatectomy 2.
• A review of 103 hypogonadal men with prostate cancer treated with testosterone after prostatectomy found that TRT was effective and did not appear to increase cancer recurrence rates, even in men with high-risk prostate cancer 3.
• A retrospective analysis of 1303 patients who underwent robot-assisted radical prostatectomy found that TRT was oncologically safe and functionally effective in symptomatic men with low serum testosterone levels 4.
• A literature review found that available evidence supports the safe application of TRT in patients previously treated for prostate cancer with either radical prostatectomy or radiotherapy 5.

Key Considerations

• TRT should be offered to select hypogonadal patients who have a history of definitively treated prostate cancer, with close monitoring of PSA levels and other safety parameters 3, 5.
• The effect of TRT on PSA levels is generally minimal, except when administered intramuscularly, and does not appear to increase the risk of prostate cancer development 6.
• More research is needed to confirm the safety and efficacy of TRT in men with a history of prostate cancer, including adequately designed randomized controlled trials 2, 5.

Study Findings

• A study found that TRT increased sexual activity, sexual desire, and energy in men with symptomatic testosterone deficiency after prostatectomy 2.
• Another study found that TRT improved erectile function and other quality-of-life concerns in patients developing testosterone deficiency after being treated for prostate cancer 5.
• A systematic review and meta-analysis found that TRT did not increase PSA levels in men being treated for hypogonadism, except when administered intramuscularly 6.