EAU 2019: Testosterone Replacement Therapy May Slow Recurrence in Low-Risk Prostate Cancer
Researchers have shown that testosterone replacement may slow the recurrence of prostate cancer in low-risk patients. Findings from the study were presented by Towe et al at the European Association of Urology (EAU) 2019 Congress (Abstract 646).
Practitioners have long regarded testosterone as a hormone that promotes prostate cancer. The 1941 work of Charles B. Huggins, MD, and Clarence V. Hodges, MD, won Huggins the 1966 Nobel Prize for Medicine for reporting the impact of testosterone reduction on prostate cancer. Since then, medicines that reduce levels of the hormone testosterone have become a standard option for many patients.
However, in the late 1990s to 2000s, doctors discovered that although men on long-term antitestosterone treatments were not dying from prostate cancer, they were dying prematurely of cardiovascular disease. It seemed that although antitestosterone therapies were treating the prostate cancer, the extremely low testosterone levels were significantly worsening metabolic complications, such as elevated blood sugar, diabetes, elevated cholesterol, and midabdomen visceral fat. Low testosterone also caused a loss of sexual function in many men on anti-androgen treatment. This led some practitioners to suggest testosterone treatment of some low-risk men after radiotherapy or surgical treatment.
Study Background
Starting in 2008, a team of doctors from the University of California, Irvine, led by Thomas Ahlering, MD, began to carefully select patients for testosterone replacement after primary treatment of prostate cancer with robotic radical prostatectomy. They hoped this method would improve recovery of sexual function.
The team worked with 834 patients undergoing radical prostatectomy. They treated 152 low-risk patients with no evidence of disease with testosterone replacement therapy. After a median of 3.1 years following surgery, they tested the patients for biochemical recurrence of cancer, as indicated by measurement of prostate-specific antigen levels.
Study Findings
The researchers found that cancer had recurred in only approximately 5% of patients treated with testosterone, whereas cancer had recurred in 15% of the patients who did not receive testosterone. Overall, after accounting for differences between the groups, they found nearly a threefold reduction by 3 years.
Dr. Ahlering commented, “This is not what we set out to prove, so it was a big surprise: not only did testosterone replacement not increase recurrence, but it actually lowered recurrence rates. While the testosterone is not curing cancer per se, it is slowing the growth of cancer, giving an average of an extra 1.5 years before traces of cancer can be found. We already know that testosterone can help with physiological markers such as muscle mass, better cholesterol and triglyceride levels, and increased sexual activity, so this seems to be a win-win.”
He continued, “There have been smaller studies that have hinted testosterone may not be risky for certain patient groups, but this is the largest such study ever conducted. We’re not suggesting that treatment methods be changed just yet, but this puts us at the stage where we need to question the taboo against testosterone use in prostate cancer therapy—especially for low-risk patients after radical prostatectomy. We need the oncology/urology community to begin to review testosterone use.”
Disclosure: The study authors’ full disclosures can be found at scientific-programme.uroweb.org/eau19.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
