Cancer Treatment Today

Little evidence exists on the safety of TRT initiation after treatment for primary prostate cancer. Agarwal et al. treated 10 hypogonadal men, treated for organ-confined prostate cancer, with TRT for a median of 18 months. They reported no PSA recurrence in all men with associated significant symptomatic improvement in quality of life indices. However, there are no documented large and long-term studies proving that the risk of recurrence is not affected by TRT in men treated with definitive therapy. A known risk of recurrence or biochemical failure after radical prostatectomy is estimated to be 10-20% within 15 years indicating that the possibility of micrometastasis at the time of diagnosis is real and substantial. On the other hand, there are strong indications that normal testosterone levels play a protective role in the natural history of prostate cancer. Many studies have demonstrated that a low testosterone level prior to treatment is an independent predictor of a more aggressive, high-grade cancer, an increased likelihood of extraprostatic disease at the time of diagnosis, and a decreased likelihood of a favorable treatment response.This group reported no PSA recurrence in all men with associated significant symptomatic improvement in quality of life indices. However, there are no documented large and long-term studies proving that the risk of recurrence is not affected by TRT in men treated with definitive therapy. A known risk of recurrence or biochemical failure after radical prostatectomy is estimated to be 10-20% within 15 years indicating that the possibility of micrometastases at the time of diagnosis is real and substantialIt is generally thought that prostate cancer is an absolute contraindication for testosterone therapy, as recommended by the WHO from the Third International Consensus Consultation on Prostate Cancer in 2002. Recommendations of The International Society for The Study of the Aging Male (ISSAM) say that ‘Androgen administration is absolutely contraindicated in men suspected of having carcinoma of the prostate or breast Cancer. However, increasing numbers of men who are hypogonadal and whose cancer were at a very early stage, has led to increasing use of testosterone. Most information is in patients treated with prostatectomy as opposed to radiation, for early prostate cancer. More recent data suggest that this recommendation can be modified in select cases, that is, when cancer is undetectable and the patient has documented hypogonadism. In men aged over 40 years without prostate cancer, DRE and PSA levels must be shown to be normal before testosterone replacement therapy is started. Follow-up monitoring at 3-6 months for the first year, then yearly thereafter has been recommended

Morales A, Lunenfeld B. Investigation, treatment and monitoring of late-onset hypogonadism in males. Official recommendations of ISSAM. Aging Male 2002; 5: 74-86.

Agarwal PK, Oefelein MG. Testosterone replacement therapy after primary treatment for prostate cancer. J Urol 2005; 173: 533-536.

Brawer MK. Testosterone replacement therapy for a man with prostate cancer. Rev Urol 2004; 6(Suppl 6): S35-37.

Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med 2004; 350: 482-492.