TESTOSTERONE therapy (TTh) in men with testosterone deficiency following radical prostatectomy (RP) for prostate cancer remains a debated topic, particularly regarding its potential impact on biochemical recurrence (BCR). This study evaluated the effect of TTh on BCR rates in men with low-to-intermediate risk, organ-confined prostate cancer.
The study included 5199 men who underwent RP, with pathology findings indicating grade groups 1 to 3 disease. Among them, 198 received TTh post-surgery, while 5001 did not. A Cox proportional hazards model was employed to assess time to BCR, with testosterone use treated as a time-dependent variable. The analysis adjusted for factors such as age, preoperative prostate-specific antigen (PSA) levels, RP grade group, and the presence of comorbidities. Men were included if their last PSA within 18 weeks of surgery was undetectable, and no BCR or loss to follow-up occurred during this period. BCR was defined as a PSA of at least 0.1 ng/mL, confirmed by a subsequent rise to the same threshold.
The median age of the testosterone group was 59 years, compared to 61 years in the non-testosterone group. Men receiving TTh were more likely to have vascular comorbidities. Clomiphene citrate was the most commonly used treatment (49%), followed by transdermal testosterone (32%) and intramuscular testosterone (19%). Analysis revealed a non-significant reduction in the risk of BCR among those receiving TTh, with a hazard ratio of 0.84 (95% CI, 0.48–1.46; P = .5). Importantly, the probability of BCR at five years was low in both groups, remaining under 2%.
These findings suggest that TTh can be safely administered to carefully selected men following RP without increasing the risk of BCR. The study adds to the growing evidence supporting the use of TTh in men with organ-confined prostate cancer, particularly those with testosterone deficiency, providing reassurance that it does not adversely impact cancer recurrence rates.
Katie Wright, EMJ
Reference
Flores JM et al. Testosterone therapy in men after radical prostatectomy for low-intermediate organ-confined prostate cancer. J Urol. 2025;213(1):27-33.
