Jody A. Charnow, Editor
CHICAGO—Studies presented at the 2019 American Urological Association annual meeting add to a growing body of evidence showing that testosterone replacement therapy (TRT) is safe for selected men with a history of prostate cancer (PCa).
The studies found no increase in the risk of adverse oncologic outcomes following treatment—even among men with high-risk PCa—or while on active surveillance. Two of these studies were co-led by J. Kellogg Parsons, MD, MHS, Professor of Urology at the University of California, San Diego, who told Renal & Urology News he believes the research to date, despite being mainly observational cohort studies, is sufficient to support the use of TRT in selected men with low-risk PCa, particularly those who have undergone definitive treatment with surgery or radiation and have no evidence of residual disease.
“It is highly unlikely that we will ever have a randomized clinical trial of hypogonadal men with prostate cancer who are randomized to testosterone replacement or no testosterone replacement,” Dr Parsons said. Such a trial would pose substantial ethical problems, and the extremely large number of patients needed would be a major challenge, he said.
Although testosterone promotes prostate tumor growth, no solid scientific evidence exists to prove that use of TRT to achieve normal testosterone levels in hypogonadal men with a history of localized PCa worsens outcomes, he said, adding that he is comfortable prescribing TRT to “appropriately selected patients.”