TRT shows benefit, no harm in post-RP patients

Testosterone replacement therapy may be considered for treatment of hypogonadism in carefully selected men who have undergone radical prostatectomy for low- to intermediate-risk prostate cancer, according to researchers from New York University Medical Center, New York.

Editor's note: This article has been updated since its original publication to include additional study data and commentary from the author/presenter.

Orlando, FL-Testosterone replacement therapy (TRT) may be considered for treatment of hypogonadism in carefully selected men who have undergone radical prostatectomy for low- to intermediate-risk prostate cancer, according to researchers from New York University Medical Center, New York.

Their statement was based on findings of a retrospective review evaluating 57 hypogonadal post-prostatectomy men with a history of clinically localized prostate cancer who received TRT and comparing them to a control group of 54 hypogonadal post-prostatectomy patients who were offered the treatment and declined. All men had low- to intermediate-risk prostate cancer (Gleason 6 or Gleason 3+4=7). A similar proportion of men in the TRT and control groups had Gleason 7 disease (58% vs. 63%), but a significantly higher proportion of the controls than TRT patients had pathologic stage ≥pT3a disease (39% vs. 19%; p<.01).

Initiation of TRT occurred at a median of 15 months after surgery. During a median follow-up from diagnosis of hypogonadism of 24 months, nine patients developed a biochemical recurrence (BCR), of which one was from the TRT group and eight were from the control group (1.8% vs. 14.8%; p<.01).

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Of the patients who developed a BCR, the single TRT patient and all but one of the patients in the control group had Gleason 7 disease, reported first author Blake Wynia, MD, urology resident at NYU Langone Medical Center.

“TRT has generally been avoided in men with prostate cancer based on in vitro studies showing that androgen administration stimulates tumor growth. However, there is a lack of good clinical evidence evaluating oncological outcomes in men with prostate cancer who receive TRT,” said Dr. Wynia, who worked on the study with Joseph Alukal, MD, and colleagues.

Long-term outcomes data needed

“Our study suggests that TRT can be offered to appropriately selected patients-those who have Gleason 7 or lower grade disease and are expected to comply with close follow-up-and it provides information to use in counseling these men as they make a decision,” Dr. Wynia said.

“However, while TRT did not appear to increase the risk of prostate cancer among the patients included in our study, it is a retrospective review with a relatively short follow-up. Prospectively gathered long-term outcomes are necessary to fully evaluate the risk-to-benefit ratio of TRT in men with a history of prostate cancer.”

The hypogonadal men included in the study were identified from among 416 patients who presented to NYU over a 5-year period between July 2008 and July 2013 for treatment of erectile dysfunction after a history of low- or intermediate-risk prostate cancer treated by radical prostatectomy. There were no significant differences between the TRT and control groups with respect to mean post-surgery PSA, mean PSA nadir, mean PSA at hypogonadism diagnosis, mean post-prostatectomy testosterone, or mean PSA change at median follow-up.

Among the TRT men, mean PSA at hypogonadism diagnosis was 0.005 ng/mL and the mean post-TRT PSA peak was 0.017 ng/mL.

Men in the TRT group had a doubling of mean testosterone level compared to baseline, from 275 to 550 ng/dL, and they were noted to have meaningful improvement in hypogonadal symptoms as the majority of treated patients reported improvement in erectile dysfunction (67%), libido (87%), and energy level (77%).

Fourteen men (23%) discontinued TRT.UT