From the Guidelines
Testosterone replacement therapy (TRT) can be considered for men after prostate cancer treatment, but should be approached cautiously and individually, with a thorough discussion of the potential risks and benefits, as stated by the American Urological Association (AUA) guideline 1.
Key Considerations
- Men should wait until they are disease-free, typically 1-2 years after successful treatment with undetectable PSA levels and no evidence of metastasis.
- TRT options include transdermal gels (AndroGel, Testim 50-100mg daily), injections (testosterone cypionate 100-200mg every 1-2 weeks), or pellets (Testopel 150-450mg every 3-6 months).
- Before starting TRT, patients should undergo baseline PSA testing, digital rectal examination, and have a discussion about potential risks, as recommended by the AUA guideline 1.
Monitoring and Follow-up
- Once therapy begins, close monitoring is essential with PSA checks on the same schedule as men without testosterone deficiency, but clinicians may choose to increase the frequency of testing, as suggested by the AUA guideline 1.
- TRT should be discontinued if PSA rises significantly or if cancer recurs, and the decision to restart therapy should be made with caution, considering the individual patient's risk-benefit ratio, as stated by the AUA guideline 1.
Shared Decision-Making
- The decision to commence testosterone therapy in men with a history of prostate cancer should involve shared decision-making between patient and physician, weighing quality of life benefits against potential risks, as recommended by the AUA guideline 1.
- Clinicians should inform patients of the absence of evidence linking testosterone therapy to the development of prostate cancer, but also discuss the inadequate evidence to quantify the risk-benefit ratio of testosterone therapy in patients with a history of prostate cancer, as stated by the AUA guideline 1.
From the Research
Testosterone Replacement Therapy After Prostate Cancer
- The use of testosterone replacement therapy (TRT) in patients with a history of prostate cancer has been a topic of debate, with some studies suggesting it can be safe and effective in select patients 2, 3, 4, 5.
- A study published in 2005 found that TRT can be administered carefully and with benefit to hypogonadal patients with prostate cancer, with no detectable prostate-specific antigen (PSA) recurrence at a median follow-up of 19 months 2.
- Another study published in 2021 reviewed the literature on TRT in patients with a history of prostate cancer and found that there is minimal or no prostate cancer growth in the setting of TRT administration in men definitively treated for non-metastatic prostate cancer 3.
- A 2013 study evaluated the safety and efficacy of TRT in hypogonadal men with prostate cancer treated with radical prostatectomy and found that testosterone therapy is effective and does not appear to increase cancer recurrence rates, even in men with high-risk prostate cancer 4.
- A 2015 review of the evidence on testosterone and prostate cancer found that there is no clear evidence that elevations in endogenous testosterone levels promote the development of prostate cancer in humans, and that TRT in select prostate cancer patients is likely safe 5.
- A randomized controlled trial published in 2023 aims to determine the safety and efficacy of testosterone treatment in men who have undergone prostatectomy for non-aggressive prostate cancer and have symptomatic testosterone deficiency, with primary endpoint being change from baseline in sexual activity 6.
Key Findings
- TRT can be safe and effective in select patients with a history of prostate cancer.
- There is minimal or no prostate cancer growth in the setting of TRT administration in men definitively treated for non-metastatic prostate cancer.
- Testosterone therapy does not appear to increase cancer recurrence rates, even in men with high-risk prostate cancer.
- TRT can improve symptoms of hypogonadism, such as low libido and erectile dysfunction, in prostate cancer survivors.
Considerations for TRT in Prostate Cancer Survivors
- Patients should be carefully selected and monitored for any signs of prostate cancer recurrence.
- TRT should only be offered after well-informed shared decision making and with close monitoring.
- Further research is needed to confirm the safety and efficacy of TRT in prostate cancer survivors.