scholarly journals Testosterone Replacement Therapy in Hypogonadal Men Following Prostate Cancer Treatment: A Questionnaire-Based Retrospective Study among Urologists in Bavaria, Germany

2015 ◽  
Vol 95 (2) ◽  
pp. 153-159 ◽  
Author(s):  
Charlotte Marie Kühn ◽  
Hans Strasser ◽  
Alexander Romming ◽  
Bernd Wullich ◽  
Peter J. Goebell
Keyword(s):  
Prostate Cancer ◽  
Replacement Therapy ◽  
High Intensity Focused Ultrasound ◽  
Testosterone Replacement ◽  
External Beam Radiation ◽  
Curative Treatment ◽  
High Dose ◽  
Testosterone Replacement Therapy ◽  
Beam Radiation ◽  
Increased Risk

Background: Several reports suggest testosterone replacement therapy (TRT) may be an option in selected hypogonadal patients with a history of prostate cancer (PCa) and no evidence of disease after curative treatment. Our aim was to assess TRT experience and patient management among urologists in Bavaria. Materials and Methods: Questionnaires were developed and mailed to all registered urologists in Bavaria (n = 420) regarding their experience with TRT in patients with treated PCa. Results: One hundred and ninety-three (46%) urologists returned the questionnaire and reported their experience with TRT in hypogonadal patients after curative treatment for PCa. Complete data was available for 32 men. Twenty-six patients (81%) received TRT after prostatectomy, 1 patient after external beam radiation, 3 patients after high-dose brachytherapy and 2 patients after high-intensity focused ultrasound. Of the PCa cases, 88.5% (23/26) were organ confined (pT2a-c), and 3 were pT3 tumors. All patients were pN0/cN0, and only 1 patient (pT3a) had a positive surgical margin status postoperatively. After a mean follow-up of 39.8 months, no biochemical relapse was observed. Conclusion: To date, there is no clear evidence to withhold TRT from hypogonadal men after curative PCa treatment. Our findings, although with limitations, fit in with the available data showing that TRT does not put patients at an increased risk after curative treatment of PCa.

Effects of testosterone deficiency or manipulation on prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 229-229
Author(s):  
Aksam Yassin ◽  
Dany-Jan Yassin ◽  
Peter Hammerer
Keyword(s):  
Prostate Cancer ◽  
Replacement Therapy ◽  
Prostate Biopsy ◽  
Specific Antigen ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Gleason Grade ◽  
Testosterone Deficiency ◽  
Increased Risk ◽  
Male Patients

229 Background: There is controversy over whether testosterone replacement therapy is a risk factor for prostate cancer. Herein, we evaluate whether testosterone deficiency (TD), testosterone replacement therapy (TRT) or 5-alpha reductase inhibitor (5-ARI) therapy affect the risk of prostate cancer. Methods: Data were collected from 224 male patients who had an indication for prostate biopsy: Prostate specific antigen (PSA) greater than 4, PSA-Velocity >=0.75 in a year, hypogonadism with PSA >=1.5, positive digital rectal exam (DRE) and/or positive Transrectal Ultrasonography (TRUS) finding. Each patient was then subjected to a TRUS-guided 10 core prostate biopsy. Results: 25% (3 out of 12) of the patients on TRT were found to have prostate cancer via biopsy and 32.1% (68 out of 212) of patients who did not receive TRT were found to have prostate cancer; insignificant with p = 0.757. Seventeen our of 76 (22.4%) of the patients on 5-ARI treatment were found to have prostate cancer and 36.5% (54 out of 148) of the patients who did not receive 5-ARI were found to have prostate cancer; significant with p = 0.03. There was no significant statistical difference in Gleason grades among patients who were on TRT, no TRT, on 5-ARI and no 5-ARI. Conclusions: Our data suggest that TRT is not associated with increased risk of prevalence or Gleason grade of prostate cancer. 5-ARI therapy is associated with lower prevalence of prostate cancer but with no relationship to Gleason grade.

scholarly journals A survey of Canadian urologists’ opinions and prescribing patterns of testosterone replacement therapy in men on active surveillance for low-risk prostate cancer

2016 ◽  
Vol 10 (5-6) ◽  
pp. 181 ◽  
Author(s):  
Adam C. Millar ◽  
Dean S. Elterman ◽  
Larry Goldenberg ◽  
Brandon Van Asseldonk ◽  
Ashley Curtis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Replacement Therapy ◽  
Active Surveillance ◽  
Low Risk ◽  
Testosterone Replacement ◽  
External Beam Radiation ◽  
Testosterone Replacement Therapy ◽  
Low Grade ◽  
Testosterone Deficiency

Introduction: Attitudes regarding the safety of testosterone replacement therapy (TRT) in hypogonadal men with prostate cancer (PCa) have changed over the past few years with the emergence of case studies suggesting a low risk of cancer progression and a better understanding of the interaction of different levels of androgen with prostate cellular metabolism. This new view has the potential to change clinical practice.Methods: Active members of the Canadian Urological Association were surveyed about their opinions on the safety of TRT in men with low-risk PCa, as well as their current prescribing habits.Results: Of 57 responding urologists, 86% actively prescribe TRT in men with testosterone deficiency syndrome (TDS), 93% are involved in the treatment of men with PCa, and 95% offer active surveillance as a management option for low-grade/low-stage disease. Furthermore, 65% stated that they would offer TRT to men with TDS who were on active surveillance for PCa and 63% believed that TRT did not increase the risk of progression of PCa in these men. In terms of treatment methods, 96% believed TRT was safe for men who have undergone radical prostatectomy, while a smaller number felt it was safe for patients who have undergone brachytherapy (86%) or external beam radiation (84%). Despite these figures, only 35% of the surveyed physicians had ever offered TRT for men on active surveillance and only 42% actually had men in their practice who were taking testosterone while on active surveillance.Conclusions: The discrepancy between urologists’ beliefs about the safety of TRT and their clinical practice patterns may be due to multiple factors, such as hesitation in recommending treatment in real-life practice, low numbers of eligible patients, absence of screening for testosterone deficiency in patients on active surveillance, and patient preference or fears. Furthermore, the difference in perceived safety in men treated by radical prostatectomy vs. radiation therapy suggests that some urologists are concerned that the radiated gland remaining in-situ may be “reactivated” by TRT. The results from this survey will be used as the basis of developing a national Canadian registry of men with low-grade/stage PCa who are receiving TRT while on active surveillance.

Long-term treatment with testosterone undecanoate injections and its effect of prostate cancer incidence in hypogonadal men.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 119-119
Author(s):  
Ahmad Haider ◽  
Michael Zitzmann ◽  
Aksam Yassin
Keyword(s):  
Prostate Cancer ◽  
Prostate Volume ◽  
External Beam Radiation ◽  
Testosterone Replacement Therapy ◽  
Beam Radiation ◽  
Testosterone Undecanoate ◽  
Testosterone Treatment ◽  
Increased Risk ◽  
Long Term Treatment

119 Background: Concerns regarding the safety of testosterone treatment, particularly regarding prostate cancer in elderly men, still hamper the use of testosterone in hypogonadal men. Methods: Registry studies of 942 men with testosterone levels less than or equal to 12.1 nmol/L from three German centers. Patients received testosterone undecanoate for up to 16 years. Results: In cohort A (mean age: 57.70 ± 6.76 years; Bremerhaven), prostate-specific antigen (PSA) increased from 1.77±0.97 to 2.0±1.01 ng/ml (p=0.0021). Prostate volume increased from 28.34±10.79 to 30.72±14.28 ml (p<0.0001). Five out of 300 patients were diagnosed with prostate cancer. The proportion was 1.7% with an incidence of 39.4 per 10,000 patient-years. In cohort B (mean age: 59.53 ± 8.35 years; Norderstedt), PSA increased from 0.86±0.57 to 1.38±0.49 ng/ml (p<0.0001). Prostate volume increased from 27.9±8.15 to 36.98±7.22 ml (p<0.0001). Six out of 261 patients were diagnosed with prostate cancer. The proportion was 2.3% with an incidence of 54.5 per 10,000 patient-years. One patient in cohort B was treated with external beam radiation, all other patients underwent radical prostatectomy. In cohort C (mean age: 42.6 ± 13.4 years; Muenster), PSA increased from 1.6±0.4 to 1.9±0.4 (p<0.001). Prostate volume increased from 16.9±5.1 to 19.9±5.3 ml (p<0.001). No patient was diagnosed with prostate cancer. Conclusions: The PLCO trial reported an incidence of 116 per 10,000 patient-years (Andriole, NEJM 360(13):1310-9), the ERSPC trial 96.6 (Schröder, NEJM 366(11):981-90). Although these screening trials cannot be directly compared to our registries of hypogonadal men receiving testosterone replacement therapy, the incidence of prostate cancer in our registry studies does not suggest an increased risk in hypogonadal men on long-term testosterone treatment.

scholarly journals Testosterone Replacement Therapy and the Risk of Prostate Cancer in Men With Late-Onset Hypogonadism

2019 ◽  
Vol 188 (9) ◽  
pp. 1666-1673 ◽  
Author(s):  
Christina Santella ◽  
Christel Renoux ◽  
Hui Yin ◽  
Oriana H Y Yu ◽  
Laurent Azoulay
Keyword(s):  
Prostate Cancer ◽  
Replacement Therapy ◽  
Late Onset ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Newly Diagnosed ◽  
Increased Risk ◽  
Late Onset Hypogonadism ◽  
The Impact

Abstract The association between the use of testosterone replacement therapy (TRT) and prostate cancer remains uncertain. Thus, we investigated whether TRT is associated with an increased risk of prostate cancer in men with late-onset hypogonadism. We used the UK Clinical Practice Research Datalink to assemble a cohort of 12,779 men who were newly diagnosed with hypogonadism between January 1, 1995, and August 31, 2016, with follow-up until August 31, 2017. Exposure to TRT was treated as a time-varying variable and lagged by 1 year to account for cancer latency, with nonuse as the reference category. During 58,224 person-years of follow-up, a total of 215 patients were newly diagnosed with prostate cancer, generating an incidence rate of 3.7 per 1,000 person-years. In time-dependent Cox proportional hazards models, use of TRT was not associated with an overall increased risk of prostate cancer (hazard ratio = 0.97; 95% confidence interval: 0.71, 1.32) compared with nonuse. Results remained consistent in secondary and sensitivity analyses, as well as in a propensity score–matched cohort analysis that further assessed the impact of residual confounding. Overall, the use of TRT was not associated with an increased risk of prostate cancer in men with late-onset hypogonadism.

Testosterone replacement therapy and prostate cancer: A word of caution

2007 ◽  
Vol 8 (3) ◽  
pp. 185-189 ◽  
Author(s):  
Timothy C. Brand ◽  
Edith Canby-Hagino ◽  
Ian M. Thompson
Keyword(s):  
Prostate Cancer ◽  
Replacement Therapy ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy
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