Rethinking Testosterone Replacement Therapy in Men With Prostate Cancer
Historically, testosterone replacement therapy (TRT) has not been recommended for men with prostate cancer due to concerns about the testosterone potentially causing the cancer to grow or recur. As such, many health care providers aim to keep prostate cancer patients’ testosterone levels low, (at times even employing androgen deprivation therapy), which can have undesirable side effects such as decreased energy, reduced sex drive, muscle loss, loss of bone density, and erectile dysfunction (ED).
Nevertheless, men’s health experts have debated the validity of these testosterone-related concerns, given the lack of scientific evidence definitively linking TRT to prostate cancer progression or recurrence. In fact, multiple studies in recent years have contradicted the claim that TRT causes prostate cancer to significantly worsen or recur in individuals who have already been treated.
One evidence-based review that appeared in Therapeutic Advances in Urology in 2015 found that while androgens may promote prostate cancer in experimental systems, there is no evidence that they promote prostate cancer growth in humans (Michaud et al., 2015). On the contrary, the review found an increasing number of studies that indicated that TRT does not increase prostate cancer growth in patients or cause worse health-related outcomes for these individuals.
In a similar vein, a 2016 meta-analysis of 26 clinical trials that examined the effect of TRT on the prostate-specific antigen (PSA) levels of 5,623 prostate cancer patients and 14,604 control participants found that TRT does not appear to raise PSA levels nor increase one’s risk of prostate cancer (Boyle et al., 2016). (PSA levels are often elevated in men with prostate cancer).
Most recently, a 2021 literature review of studies evaluating the effectiveness and safety of TRT for patients who have been treated for localized prostate cancer found that the available evidence thus far supports TRT as a safe option for prostate cancer patients (Natale et al., 2021).
While further research in the form of large, randomized, prospective, placebo-controlled trials would strengthen these results, the existing evidence suggests that TRT is likely a safe, effective treatment for men with prostate cancer. This information could have major ramifications for the treatment of prostate cancer, hopefully sparing patients the negative side effects of low testosterone and improving their overall quality of life moving forward.
Boyle, P., Koechlin, A., Bota, M., d'Onofrio, A., Zaridze, D.G., Perrin, P., Fitzpatrick, J., Burnett, A.L., & Boniol, M. (2016). Endogenous and exogenous testosterone and the risk of prostate cancer and increased prostate-specific antigen (PSA) level: a meta-analysis. BJU international, 118(5), 731-741. DOI: 10.1111/bju.13417
Michaud, J.E., Billups, K.L., & Partin, A.W. (2015). Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk. Therapeutic advances in urology, 7(6), 378–387. DOI: https://doi.org/10.1177/1756287215597633
Natale, C., Carlos, C., Hong, J., Khera, M., Baum, N., & Raheem, O. A. (2021). Testosterone therapy after prostate cancer treatment: a review of literature. Sexual medicine reviews, 9(3), 393-405. DOI: https://doi.org/10.1016/j.sxmr.2020.12.003