From the Research
Patients with prostate cancer should wait at least 1-2 years after successful treatment with no evidence of disease before considering testosterone replacement therapy (TRT), as supported by the most recent and highest quality study 1. This recommendation is based on the latest evidence from a 2025 study published in The Journal of Urology, which found no evidence that testosterone therapy after radical prostatectomy causes biochemical recurrence in select men with low-intermediate organ-confined prostate cancer. The waiting period allows for monitoring of PSA levels and confirmation that the cancer is truly in remission. Before initiating TRT, patients should undergo a thorough evaluation including:
- PSA testing
- Digital rectal examination
- Possibly imaging studies When TRT is started, it should begin at a low dose (such as 50mg testosterone gel daily or 100mg testosterone cypionate injection every 2 weeks) with close monitoring of PSA levels every 3-6 months during the first year, then annually thereafter. The concern with TRT in prostate cancer patients stems from the fact that prostate cancer cells may be stimulated by testosterone, potentially leading to cancer recurrence or progression. However, more recent evidence suggests that carefully monitored TRT may be safe in selected patients with treated, localized prostate cancer who have symptoms of testosterone deficiency, as noted in studies such as 2, 3, and 4. The decision should always be individualized based on the patient's cancer characteristics, treatment history, and discussion of potential risks and benefits. It is essential to prioritize the patient's quality of life, morbidity, and mortality when making this decision, and to consider the latest evidence from high-quality studies like 1.