Testosterone therapy may be safe for use in men with advance
Testosterone therapy was not associated with unexpected or rapid disease progression in a cohort of men with biochemical recurrence or metastatic prostate cancer, according to study findings.

Although prostate cancer (PCa) has long been considered an absolute contraindication for testosterone therapy (TTh), growing literature suggests TTh may be safely offered to men with localized PCa. We here present a single-center series of men treated with TTh for relief of symptoms, despite having more advanced disease, namely biochemical recurrence (BCR) or metastatic PCa (MET).

Researchers identified men treated with TTh with BCR, MET, or adjuvant androgen deprivation therapy (ADT). Consent included risks of rapid PCa progression and death. Laboratory and clinical results were analyzed.

Results:
-- Twenty-two men received TTh: 7 with BCR, 13 with MET, and 2 with adjuvant ADT. Median age was 70.5 years (range 58–94).

-- Median TTh duration was 12 months (range 2–84) overall, including 20 months for BCR and 9.5 months for MET.

-- Mean serum testosterone (T) increased from 210 to 1111?ng/dL. Median PSA increased from 3.1?ng/mL to 13.3?ng/mL in the BCR group, 6.3?ng/mL to 17.8?ng/mL in the MET group, and 0.1 to 0.3?ng/mL in the ADT group.

-- All patients reported symptom relief, especially improved vigor and well-being.

-- Overall mortality was 13.6% and PCa-specific mortality was 4.5% during the period of TTh and 6 months after discontinuation.

-- Seven of 10 with follow-up imaging within 12 months showed no progression.

-- Five men have died: three during TTh and two succumbed at 2 years or longer after discontinuing TTh.

-- One of the three deaths during TTh was PCa-specific. Three men developed significant bone pain at 7–41 months; two discontinued TTh and one continued, after focal radiation.

-- There were no cases of rapid-onset complications, vertebral collapse, or pathological fracture.

Conclusively, these initial observations indicate TTh was not associated with precipitous progression of PCa in men with BCR and MET, suggesting a possible role for TTh in selected men with advanced PCa whose desire for improved quality of life is paramount.

Source: https://www.liebertpub.com/doi/full/10.1089/andro.2021.0001
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