Men who receive testosterone replacement therapy (TRT) have been found to have a lower incidence of prostate cancer (PCa) than those not receiving TRT, according to study findings presented at the Sexual Medicine Society of North America 18th Annual Fall Scientific Meeting in San Antonio, Texas.
In addition, PCa diagnosed in TRT recipients is less severe than PCa diagnosed in men unexposed to TRT.
Dr. Ahmad Haider and colleagues, in a private urology practice in Germany, studied 400 men with low testosterone levels, ( <350 ng/dL) who received injectable testosterone 1000 mg every 3 months for up to 10 years VS 376 others with low T levels who opted against TRT (control group).
- During a median follow-up of 8 years,
- 9 men in the TRT group (2.3%) were diagnosed with Prostate cancer
- 26 (6.9%) in the control group were fdiagnosed with prostate cancer
- The incidence was 31 per 10,000 years in the TRT group compared with 95 per 10,000 years in the control group.
- “In the testosterone group, all prostate cancers were diagnosed within the first year and a half suggesting that cancers had been present prior to initiating testosterone therapy,” Dr Haider said. “Because low testosterone is associated with low PSA, hypogonadism may contribute to reduced detectability of prostate cancer. Normalizing testosterone may have brought out the occult cancer.” He added: “Our registry is ongoing, and we keep following our patients year after year. The results are getting more robust with advancing time.”
The new findings add to those from previous studies showing a protective effect of TRT against prostate cancer.
- Stacy Loeb, MD, of New York University, and colleagues published the results of a case-control study in the Journal of Clinical Oncology(2017;35:1430-1436) showing that men who received TRT had a decreased risk of aggressive PCa. Using the National Prostate Cancer Register of Sweden, the investigators compared 38,570 patients with PCa and 192,838 age-matched men without PCa (controls). Of these, 284 patients with PCa (1%) and 1378 (1%) controls filled TRT prescriptions. In multivariable analysis, the investigators found no association between TRT and overall PCa risk. Patients who received TRT had a significant 35% increased odds of more favorable-risk PCa and 50% decreased odds of aggressive PCa compared with patients not exposed to TRT.
- In a population-based matched cohort study of men aged 66 years or older in Ontario, Canada, Christopher J.D. Wallis, MD, PhD, and colleagues from the University of Toronto found that TRT recipients in the highest tertile of testosterone exposure had a significant 40% decreased risk of a PCa diagnosis compared with controls, according to a paper published in Lancet Diabetes Endocrinology(2016;4:498-506). The study included 10,311 men who received TRT and 28,029 controls. Median follow-up was 5.3 years in the TRT group and 5.1 years in the control group.
- in a study published in the Aging Male(2017;20:125-133), Aksam Yassin, MD, from the Institute of Urology and Andrology, Segeberger Kliniken, Norderstedt, Germany, and colleagues found that hypogonadal men who received TRT had a lower rate of PCa found on prostate biopsy compared with hypogonadal men not exposed to TRT and eugonadal men (16.7% vs 51.8% vs 37.8%, respectively). They also were less likely to have less severe PCa as determined by grading and staging.
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- Haider A, Haider K, Saad F. Prostate cancer incidence and severity in testosterone-treated vs. untreated hypogonadal men: Real-life experience from more than 5500 patients years.Poster presented at the Sexual Medicine Society of North America 18th Fall Annual Meeting in San Antonio, October 26-29, 2017. Poster 131.
- Loeb S, Folkvaljon Y, Damber JE, et al. Testosterone replacement therapy and risk of favorable and aggressive prostate cancer. J Clin Oncol2017;35:1430-1436.
- Wallis CJ, Lo K, Lee Y, et al. Survival and cardiovascular events in men treated with testosterone replacement therapy: an intention-to-treat observational cohort study.Lancet Diabetes Endocrinol. 2016;4:498-506.
- Yassin A, Salman M, Talib RA, Yassin DJ. Is there a protective role of testosterone against high-grade prostate cancer? Incidence and severity of prostate cancer in 553 patients who underwent prostate biopsy: a prospective data register. Aging Male. 2017;20:125-133.