Abstract
OBJECTIVE: Testosterone replacement therapy (TRT) in prostate cancer survivors with hypogonadism remains controversial due to concerns that restoring testosterone may increase the risk of disease recurrence. We performed a cohort study of men with localized prostate cancer treated with radiotherapy with or without androgen deprivation therapy (ADT), who received TRT, and a narrative review of published studies evaluating TRT after radiotherapy. METHODS: Biochemical and clinical recurrence, patient-reported symptoms, prostate-specific antigen, testosterone, and hemoglobin were analyzed in this cohort and published studies. RESULTS: Among 33 men with pathology-confirmed prostate cancer treated with radiation without or with ADT, who received TRT (median age at TRT initiation, 75 [IQR 69.0-77.0] years), median testosterone increased from 66.0 (IQR 16.0-140.0) to 299.3 (IQR 152.5-569.0, P < .001) ng/dL. Prostate-specific antigen rose from 0.04 (IQR 0.02-0.17) to 0.17 ng/mL (IQR 0.04-0.44) (P = .018). TRT was associated with improvements in fatigue, mood, and sexual symptoms; anemia was corrected in 9 of 21 (42.9%) patients with anemia. One patient (3%) developed metastatic disease 3 years after starting TRT. In narrative review of published case-reports, weighted mean biochemical recurrence rate was 3.3% during mean 42.6 months of follow-up. CONCLUSIONS: Our cohort study and narrative review found a low incidence of biochemical recurrence in prostate cancer survivors treated with radiation therapy with or without ADT. TRT was associated with correction of anemia and improvements in fatigue, energy, and sexual symptoms. These findings provide the ethical and scientific rationale for a randomized controlled trial to evaluate the safety and efficacy of TRT in this population.