Dr. Bernie on testosterone therapy for men on active surveillance

In this video, Helen L. Bernie, DO, MPH, highlights the lack of long-term data on testosterone therapy for men on active surveillance for prostate cancer. Bernie discussed this topic during a panel session at the 2024 American Urological Association Annual Meeting titled, “Controversies in Urology: Testosterone Therapy may be Reasonably Offered to Men on Active Surveillance- Pro/Con.” Bernie is the director of sexual and reproductive medicine at Indiana University and an assistant professor of urology at Indiana University School of Medicine in Indianapolis, Indiana.

Video Transcript:

They 2018 AUA guidelines for testosterone therapy that were co-chaired by Dr. John P. Mulhall say that we have an absence or a paucity of data on using testosterone therapy on active surveillance. It does say that in patients that have been treated–definitively treated like with a radical prostatectomy–that you can offer patients testosterone therapy based on a risk-based discussion with them and letting them know that there's an absence of long-term data on the risk profile of taking testosterone therapy. I will pretty much prescribe testosterone to anyone that is not on ADT. I do have a very detailed discussion with my patients that there's A) an absence of long-term data, B) that the data that is out there does not show any increased risk of prostate cancer progression, staging, or biochemical recurrence in low-, intermediate- or high-risk prostate cancer patients, and then if they want to be on it, then we have them on a protocol where they're going to get labs rechecked by me every 3 months. If I see a PSA rise, I'll use a repeated a month later. If it continues to go up, then I have a discussion with them. Are we going to meet with your urologic oncologist? Are we going to meet with your medical oncologist, or a radiation oncologist depending on what their therapy was? And we'll make a decision together about whether we're going to keep you on the testosterone, or if maybe we're going to stop and look into other modalities or treatment options for prostate cancer.

This transcription has been edited for clarity.