Cancer Research Lab

Testosterone replacement therapy (TRT) appears safe for men who experience hypogonadal symptoms after brachytherapy for prostate cancer.

“Men who have undergone potentially curative treatment for prostate cancer but also suffer from severe effects of hypogonadism may benefit from a trial of testosterone replacement, with close monitoring of the PSA,” Dr. Michael F. Sarosdy from South Texas Urology and Urologic Oncology, San Antonio, said. “In our experience, most have done well.”

Dr. Sarosdy investigated the long-term effects of TRT in 31 men after treatment for prostate cancer using brachytherapy. The findings are published in the February 1st issue of Cancer.

TRT was begun a median 2.0 years after brachytherapy, the report indicates. Treatment with testosterone ranged from 0.5 years to 8.5 years (median, 4.5 years).

Only one patient showed any rises in PSA after TRT, and all rises were followed by declines. Three quarters of patients had PSA values below 0.1 ng/mL at last follow-up, and all 31 patients had PSA values below 1.0 ng/mL.

None of the patients had to stop using TRT because of possible or confirmed recurrence or progression of prostate cancer.

“TRT in these patients should be driven by presence of symptoms of low testosterone, not simply a low testosterone blood test,” Dr. Sarosdy said.

“Until more confirmatory data are available, those with low testosterone but no major hypogonadal symptoms should probably be followed rather than treated, as we’ve done in such patients.”

“A randomized trial might be scientifically desirable, but given the lack of substantial numbers of events or failures in this report, such a study would likely have to include a thousand or more patients to reach valid endpoints,” Dr. Sarosdy added.