Safety of testosterone therapy in men with prostate cancer

ABSTRACT

Introduction: The use of testosterone therapy (TTh) in men with prostate cancer (PCa) is relatively new, and controversial, due to the longstanding maxim that TTh is contraindicated in men with PCa. Scientific advances have prompted a reevaluation of the potential role for TTh in men with PCa, particularly as TTh has been shown to provide important symptomatic and general health benefits to men with testosterone deficiency (TD), including many men with PCa who may expect to live 30–50 years after diagnosis.

Areas covered: This review outlines the historical underpinnings of the historical belief that TTh ‘fuels’ PCa and the experimental and clinical studies that have radically altered this view, including description of the saturation model. The authors review studies of TTh in men with PCa following radical prostatectomy and radiation therapy, in men on active surveillance, and in men with advanced or metastatic PCa.

Expert opinion: TTh provides important symptomatic and overall health benefits for men with PCa who have TD. Although more safety studies are needed, TTh is a reasonable therapeutic option for men with low-risk PCa after surgery or radiation. Data in men on active surveillance are limited, but initial reports are reassuring.

KEYWORDS:

• Active surveillance
• androgens
• androgen deprivation therapy
• prostate cancer
• prostate cancer radiation
• prostatectomy
• saturation model
• PSA
• testosterone deficiency
• testosterone therapy

Article highlights

• Many men with a history of prostate cancer suffer from testosterone deficiency.

• Testosterone therapy in these men improves symptoms and confers significant health benefits, including improved sexual function, increased energy and sense of wellbeing, loss of fat mass and gain in lean mass, resolution of anemia, and increased bone mineral density.

• Although no large, long-term, controlled studies have yet been performed to provide definitive evidence regarding the safety of testosterone therapy in men with prostate cancer, the available data is reassuring.

• Testosterone therapy may be reasonably offered to symptomatic men with testosterone deficiency who have low-risk disease after treatment for localized prostate cancer with surgery or radiation.

• Testosterone therapy in men on active surveillance is less well established, however several initial reports have shown progression rates comparable to those seen in men who did not receive testosterone therapy.

• New clinical trial data suggests there may even be a therapeutic role for testosterone therapy in men with advanced prostate cancer.

This box summarizes key points contained in the article.

Declaration of interest

A Morgentaler is a consultant for Aytu and Antares, a meeting participant for Acerus, and has received a research grant from Endo. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.