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Testosterone Therapy In Hypogonadal Men And Potential Prostate Cancer Risk: A Systematic Review

July 07, 2017

UroToday - In the online edition of the International Journal of Impotence Research, Dr. R. Shabsigh and his associates presented a systematic review of testosterone therapy for hypogonadism and its relation to prostate cancer (CaP). The data did not suggest that testosterone therapy is associated with increased CaP risk in hypogonadal men nor demonstrate a consistent effect on PSA levels.

The benefits of testosterone therapy include improvements in low libido, erectile dysfunction, fatigue, decreased muscle strength, bone mineral density, increased body fat, anemia, hot flashes, and mood changes. It is balanced by potential adverse effects of BPH, sleep apnea, gynecomastia, erythrocytosis, testicular atrophy, fluid retention and local reaction at injection sites.

The systematic review ultimately evaluated 44 articles meeting inclusion criteria. Of these studies, 11 were placebo controlled, randomized trials, and 29 not placebo controlled (15 prospective and 14 retrospective). In the placebo-controlled trials, CaP was detected in 7 of 542 men on testosterone therapy (1.3%) and in 5 of 333 men on placebo (1.5%). The CaP incidences from the studies varied from 0% for both groups to 9.5% for the testosterone therapy group and 21% for the placebo group. CaP was detected as early as at 3 months in the patients receiving testosterone therapy and at 6 months in the placebo groups. In both groups prostrate volume increased to a similar degree over the 3-year study periods. Histologic changes in men on testosterone therapy did not differ from placebo patients. In the non-placebo controlled trials, several cases of CaP were detected in men on testosterone therapy for 7, 15 and 35 years. Otherwise no clear difference was identified.

Studies of testosterone therapy in men with a history of CaP were also examined. Four studies (1 prospective and 3 retrospective) showed no evidence of CaP recurrence over periods of 6 months to 12 years.

Shabsigh R, Crawford ED, Nehra A, Slawin KM
Int J Impot Res. 2008 Jul 17. Epub ahead of print.
doi:10.1038/ijir.2008.31

UroToday Contributing Editor Christopher P. Evans, MD, FACS

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