Testosterone doesn’t worsen lower urinary tract symptoms in men with BPH

San Diego-A new study has found that testosterone replacement doesn’t worsen lower urinary tract symptoms related to an enlarged prostate. In fact, many men saw their symptoms improve, apparently with little effect on their prostate gland.

“You’d think you’d worsen prostate trouble with testosterone,” co-author Kevin McVary, MD, professor and chair of urology at Southern Illinois University School of Medicine, Springfield, told Urology Times. “That makes sense, but it turns out there’s no evidence to support the assumption. Our research suggests that you can treat men with hypogonadism and related lower urinary tract symptoms with testosterone supplementation, and you really don’t have to worry that they’re going to get in trouble.”

About 20% to 30% of men with LUTS also suffer from enlarged prostates, said Dr. McVary, who worked on the study with colleagues from Northwestern University in Chicago. “But the drug inserts from the FDA warn that their prostate symptoms will worsen if you give them testosterone. We have a group of men who have been on testosterone supplementation, so we thought we might be able to actually address whether this is an issue.”

Dr. McVary and colleagues reviewed the medical records of 120 hypogonadal men from the Northwestern Memorial Faculty Foundation outpatient database who received testosterone replacement therapy from 2002-2012. Most received topical therapy or a combination of topical and pellet-based therapy (57.5% and 20.8%, respectively).

The men were screened for LUTS before and after they went on testosterone therapy.

The mean baseline PSA was 1.6 and the mean change in PSA was 0.44; 6.7% of patients had a baseline PSA over 4.0 ng/mL, and they had greater improvement in AUA Symptom Index (AUA-SI) than those patients with baseline PSA under 4.0 ng/mL.

Nearly half experience change in AUA-SI

As reported at the AUA annual meeting in San Diego, almost 46% of men had a change of more than 3 points in AUA-SI in either direction; 31.7% saw their AUA-SI improve by more than 3 points while 22.5% had worsening by more than 3 points.

Patients with an improved AUA-SI had an average PSA change of 0.3, while those whose AUA-SI worsened had an average PSA change of 0.7.

About 7.5% of the men in the study began taking new medications for LUTS during the study, but there was no change in their AUA-SI compared to patients who didn’t adjust their medications. A total of 3.3% of patients saw their symptoms worsen and required transurethral resection of the prostate.

While the study suggests that testosterone treatment is appropriate for men with enlarged prostates, Dr. McVary cautions that it is still crucial to “follow them and do the same types of checks.” However, he said, it’s not necessary to warn patients that they may be at risk.

Will the study findings make a difference in how urologists do their jobs?

“I don’t think the whole world is going to change because of our 120 patients,” Dr. McVary said. “However, we’re understanding more about the implications of testosterone therapy. This is another chapter in that story.”

Dr. McVary is a consultant/adviser to Allergan, Lilly, NeoTract, NxThera, and Watson, and a meeting participant/lecturer for GlaxoSmithKline.UT

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