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15 September 2018

Changes in testosterone levels within individuals and risk of prostate cancer in hypogonadal men

Changes in testosterone levels within individuals and risk of prostate cancer in hypogonadal men
A long-held belief is that high testosterone levels increase risk of prostate cancer. To the contrary, most studies show that it is low testosterone that increases risk of prostate cancer. Furthermore, emerging data – summarized here - suggest that it may not be the absolute level of testosterone that predicts prostate cancer development, but rather patterns of change in testosterone levels, such as steep declines with age or reductions in testosterone at younger age. Maintaining stable testosterone levels throughout lifespan with testosterone therapy may have a significant impact on prostate cancer prevention.

15 November 2016

Testosterone Therapy in Men with Prostate Cancer – new research

Testosterone Therapy in Men with Prostate Cancer – new research

Testosterone Therapy in Patients with Treated and Untreated Prostate Cancer: Impact on Oncologic Outcomes. Ory J, Flannigan R, Lundeen C, Huang JG, Pommerville P, Goldenberg SL. J Urol. 2016;196(4):1082-1089.

Historically, prostate cancer – both active and treated - has been an absolute contraindication to testosterone therapy and – from a regulatory perspective – still is. The incidence of prostate cancer is higher in older men, in whom prostate cancer accounts for one in five new cancer diagnoses. Thanks to improvement in early detection and treatment of prostate cancer, prostate cancer mortality has decreased 50% during the past two decades, and more men are living with a history of prostate cancer.

The aging of the male population and the increasing number of prostate cancer survivors have resulted in a significant increase in the number of men presenting with hypogonadism and treated prostate cancer. Therefore, it is important to consider the growing number of recent studies which have challenged the long-standing belief that prostate cancer is an absolute contraindication to testosterone therapy. Here we summarise the results of a notable study which investigated the effects of testosterone therapy in men with treated and untreated prostate cancer, and conclude with the latest recommendations on managing testosterone deficiency in men with history of prostate cancer.

Key Points

  • An initial increase in PSA when starting testosterone therapy is normal and is not synonymous with prostate disease progression.
  • Emerging research shows that testosterone therapy in men after radical prostatectomy or radiation, and in men on active surveillance, in most cases does not cause prostate cancer recurrence or worsening.
  • The risk of prostate cancer recurrence appears to be lower after radical prostatectomy than after radiation.

15 October 2016

Dispelling the myth of testosterone treatment and prostate cancer

Dispelling the myth of testosterone treatment and prostate cancer

Testosterone treatment is not associated with increased risk of prostate cancer or worsening of lower urinary tract symptoms: prostate health outcomes in the Registry of Hypogonadism in Men. Debruyne FM, Behre HM, Roehrborn CG, et al. BJU Int. 2017;119(2):216-224.

Fear of prostate cancer remains one of the major concerns with testosterone therapy among doctors, and reason to deny suffering hypogonadal men testosterone treatment. This fear persists despite mounting research over the past decade that has clearly refuted the belief that testosterone therapy increased risk of prostate cancer among men in the general population. Aside prostate cancer, benign prostatic hyperplasia (BPH) with its associated lower urinary tract symptoms (LUTS) are also common concerns with testosterone therapy.

In this editorial we summarize and comment on the results of the Registry of Hypogonadism in Men (RHYME) study; a large, multi-national prospective registry of men with testosterone deficiency, which was designed and powered specifically to assess prostate cancer outcomes in hypogonadal men receiving testosterone therapy compared with untreated hypogonadal men or general population estimates.



Key Points

  • BPH, LUTS and prostate cancer have long been considered major risks associated with testosterone therapy, but accumulating research shows these fears are unfounded.
  • The RHYME study showed that testosterone therapy does not increase prostate cancer incidence or BPH/LUTS progression compared to matched untreated men.
  • There were no differences in PSA levels, total IPSS, or the IPSS obstructive sub-scale score in testosterone treated men compared to untreated men.
  • Testosterone therapy may improve voiding symptoms.
  • Testosterone therapy has no clinically significant adverse impact on prostate cancer incidence among men regardless of administration method.

15 May 2016

Survival and cardiovascular events in men treated with testosterone

Survival and cardiovascular events in men treated with testosterone

Survival and cardiovascular events in men treated with testosterone replacement therapy: an intention-to-treat observational cohort study. Wallis CJD, Lo K, Lee Y, et al. The Lancet Diabetes & Endocrinology. 2016;May 7

On the surface, testosterone therapy is a controversial treatment because previous studies investigating the effects of testosterone therapy have been conflicting, with some studies showing supposed harm and others showing significant benefit.

Here we present the results of a new study published in The Lancet Diabetes & Endocrinology on May 7 2016, which addressed some shortcomings in previous studies by analyzing effects based on duration of testosterone treatment.



Key Points

  • After a follow-up for over 5 years, men treated with testosterone had 12% lower mortality than non-testosterone treated men.
  • Compared to non-testosterone treated men, men with the shortest duration of testosterone treatment had 11% increased risk of mortality and 26% increased risk cardiovascular events. In contrast, those with the longest duration of testosterone treatment had 33% decreased risk of mortality and 16% decreased risk of cardiovascular events.
  • Risk of prostate cancer diagnosis was decreased by 40% in men with the longest duration of testosterone treatment, compared to non-testosterone treated men. No effect on prostate cancer risk was seen among men with shortest duration of testosterone treatment.
  • It is speculated that the increased risk of cardiovascular events and mortality for men with the shortest duration of testosterone treatment could be driven by the consequences of underlying testosterone deficiency and inadequate treatment, rather than the testosterone treatment.

16 July 2014

Testosterone and Prostate Cancer - a paradigm shift

Testosterone and Prostate Cancer - a paradigm shift

"Bye-bye Androgen Hypothesis, Welcome Saturation Model"

A new era of testosterone and prostate cancer: from physiology to clinical implications. Khera M, Crawford D, Morales A, et al., Eur Urol 2014; 65(1): 115-23.

A long-held belief is that testosterone stimulates development of prostate cancer (PCa) and/or accelerates its growth. This summary gives an overview of an in-depth review of current literature regarding the relationship of serum testosterone and PCa and the effect of testosterone replacement therapy (TRT) on PCa progression and recurrence. Key studies which have refuted the old belief that testosterone has harmful effects on the prostate are presented, along the new testosterone-prostate paradigm known as the saturation model.


Last updated: 2019
G.MKT.GM.MH.02.2018.0506