Testosterone replacement therapy reduces biochemical recurrence after radical prostatectomy

Abstract

Objective To evaluate risk of prostate cancer biochemical recurrence (BCR) after radical prostatectomy (RP) in men receiving vs not receiving testosterone replacement therapy (TRT). Patients and Methods A total of 850 patients underwent RP by a single surgeon. All patients had preoperative testosterone and sex hormone‐binding globulin levels determined; free testosterone was calculated prospectively. In all, 152 (18%) patients with low preoperative calculated free testosterone (cFT) levels and delayed postoperative sexual function recovery were placed on TRT and proportionately matched to 419 control patients by pathological Gleason Grade Group (GGG) and stage. Rates and time to BCR [two consecutive prostate‐specific antigen (PSA) levels of ≥0.2 ng/mL] were compared in univariate and multivariate regression; Cox regression was used to generate a survival function at the mean of covariates. Results The median follow‐up was 3.5 years. There were no statistically significant differences in demographics or general health complications between groups. BCR occurred in 11/152 (7.2%) and 53/419 (12.6%) patients in the TRT and control groups, respectively. In adjusted time‐to‐event analysis, TRT was an independent predictor of recurrence‐free survival. After accounting for GGG, pathological stage, preoperative PSA level, and cFT, patients on TRT were ~54% less likely to recur (hazard ratio 0.54, 95% confidence interval 0.292–0.997). In men destined to recur, TRT delayed time to recurrence by an average of 1.5 years. Conclusion In our experience, TRT after RP significantly reduced BCR and delayed time to BCR. There was no identifiable general health complications associated with TRT. These findings are hypothesis‐generating and require confirmation with multi‐centred, prospective randomised controlled trials.

Strategies for Testosterone Therapy in Men with Metastatic Prostate Cancer in Clinical Practice: Introducing Modified Bipolar Androgen Therapy

“…17 In a study of 850 men who underwent radical prostatectomy, Ahlering et al recently reported a lower biochemical recurrence rate (7.2%) among 152 men who received postoperative TTh compared with 419 proportionately matched controls who did not receive TTh (12.6%). 18 The most intriguing evidence for a possible role for TTh in men with mPCa comes from the BAT trials involving rapidly cycling supraphysiological and castrate levels of serum T. These landmark trials demonstrated 50% or greater declines in PSA in 7 of 14 evaluable men with castrate-resistant mPCa and radiographic responses in 5 of 10 evaluable cases. 15 A subsequent trial also re-established androgen sensitivity in men with CRPC.…”

Updated Review of Testosterone Replacement Therapy in the Setting of Prostate Cancer

“…After accounting for the Gleason grade (GG) group, pathological stage, preoperative PSA level, and calculated free T, the authors determined that patients prescribed TRT were *54% less likely to recur (HR 0.54, 95% CI 0.292-0.997). 51 Among those men who would eventually recur, TRT appeared to delay time to recurrence by an average of 1.5 years. Importantly, this study reported that by 2 years post-RP, 96% of patients had re-gained erectile function.…”

“…An important limitation of this study was that younger men were included, unlike the PLCO and ERSPC trials. 28 In a case-control study in the United States, using a Surveillance, Epidemiology and End Results (SEER) Medicare-linked database, patients with a diagnosis of PCa and with history of T use (574 men) were compared with PCa patients without history of T use (51,945). Those patients who had received TRT in the 5 years before diagnosis were found not to have an increased risk of high-grade disease at diagnosis (odds ratio [OR] 0.84, 95% CI 0.67-1.05).…”

Journal watch

“…Ahlering T, et a.l, 4 answered the question with their study in 2020, in which 152 men with low testosterone, post-radical prostatectomy treated with TT were compared with 419 controls with a normal testosterone post-op. The median follow-up was 3.5 years.…”