Testosterone Replacement Therapy in Men with Prostate Cancer on Active Surveillance: A Systematic Review of Safety
Keywords:
Prostatic neoplasms; testosterone; hormone replacement therapy; active surveillance; disease progressionAbstract
Introduction: Testosterone replacement therapy (TRT) is generally avoided in men with prostate cancer (PCa) due to concerns about stimulation of cancer growth. This review examines the safety of TRT in men with untreated low-risk PCa on active surveillance (AS).
Methods: PubMed, Cochrane, and clinicaltrials.gov were searched (2010–2024) for prospective studies and retrospective series. Inclusion: men with biopsy-proven low-risk PCa on AS receiving TRT for ≥12 months. Primary outcomes: PSA velocity, new positive biopsies, and histologic progression (Gleason upgrade). Controls were men on AS without TRT.
Results: Seven studies (n=378 TRT, n=542 controls) met criteria. Mean PSA velocity was 0.21 ng/mL/year in TRT vs. 0.18 in controls (p=0.54). New positive biopsies occurred in 26% TRT vs. 23% controls (p=0.41). Gleason upgrade (to 4+3 or higher) was 7% in both groups (p=0.96). No difference in time to treatment. Mean follow-up 2.5 years.
Discussion: Short-term (≤3 years) TRT appears not to accelerate progression in carefully selected low-risk PCa on AS. Limitations include short follow-up, small sample sizes, and possible selection bias (hypogonadal men only). Long-term (>5 year) data are absent.
Conclusions: Current evidence does not support a blanket contraindication to TRT in men with low-risk prostate cancer on active surveillance, provided rigorous monitoring is performed. However, larger and longer trials are urgently needed.
