TRT in older men not linked to increased prostate cancer risk

The risk of developing prostate cancer among older men who receive testosterone replacement therapy for low testosterone is no greater than it is for similarly aged men not treated with testosterone, according to a study presented at The Endocrine Society’s annual meeting in San Francisco.

“Testosterone treatment stimulates the growth of an existing prostate cancer, but there is no evidence that it causes this type of cancer,” said lead author Aksam Yassin, MD, PhD, of the Clinic for Urology and Andrology of the Segeberger Clinics in Norderstedt, Germany.

Researchers from Germany and the United Arab Emirates assessed whether prostate cancer occurs more often with testosterone replacement therapy in men over age 50 years. The study involved 154 testosterone-deficient men (average age, 56 years) who had 1 to 3 years follow-up testing. The men were treated with the slow-release form of the hormone, testosterone undecanoate (Nebido), which is not currently available in the United States. Researchers compared these patients with 160 men (average age, 58 years) with normal testosterone levels who were not teated with testosterone.

All study participants had an evaluation at baseline and every 3 months that consisted of a digital rectal exam, ultrasound measurement of prostate volume, and PSA test. DRE found no abnormalities. Eleven men receiving testosterone had a biopsy, in which two men showed a small, cancerous tumor on one side of the prostate. A third man was found to have high-grade prostate cancer that had not yet spread. Of the 12 men in the untreated group, five had prostate cancer. Four of the tumors were on both sides of the prostate and were high grade.

The study authors concluded that no more prostate cancers were found in the group who received testosterone treatment than in the control group. Additionally, those receiving testosterone had smaller, less aggressive tumors than did the other men.

“In view of the many benefits of [testosterone] treatment and the results of our study, we believe it is acceptably safe to treat older men with testosterone if there is a good reason for treatment,” Dr. Yassin said.

Dr. Yassin is on the speakers’ bureau for Bayer Schering.