Can testosterone therapy be offered to men on active surveillance for prostate cancer？ Preliminary results

• Published in: Asian journal of andrology 2016-01, Vol.18 (1), p.16-20
• Main Authors: Kacker, Ravi, Hult, Mariam, San Francisco, Ignacio F, Conners, William P, Rojas, Pablo A, Dewolf, William C, Morgentaler, Abraham
• Format: Article
• Language: English
• Subjects: active surveillance; prostate cancer; testosterone; Aged; Androgens; Biopsy; Cancer therapies; Care and treatment; Data collection; Disease Progression; Hormone therapy; Humans; Hypotheses; Invited Original; Male; Medical Audit; Mens health; Middle Aged; Physiological aspects; Prostate cancer; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - pathology; Retrospective Studies; Surveillance; Testosterone; Testosterone - therapeutic use; Watchful Waiting; 主动监测; 供给; 前列腺癌; 平均年龄; 治疗; 男性; 监督; 睾酮
• ISSN: 1008-682X; 1745-7262
• DOI: 10.4103/1008-682X.160270

This report presents our experience with T therapy in a cohort of T-deficient men on active surveillance （AS） for Gleason 3 ＋ 3 and Gleason 3 ＋ 4 prostate cancer （PCa）. A retrospective chart review identified 28 men with T deficiency who underwent T therapy （T group） for at least 6 months while on AS for PCa. A comparison group of 96 men on AS for PCa with untreated T deficiency （no-T group） was identified at the same institution. The AS protocol followed a modified Epstein criteria and allowed inclusion of men with a single core of low-volume Gleason 3 ＋ 4 PCa. Mean age was 59.5 and 61.3 years, and mean follow-up was 38.9 and 42.4 months for the T and no-T groups, respectively. Of all 28 men in the T group, 3 （10.7%） men developed an increase in Gleason score while on AS. Of 22 men in the T group with Gleason 3 ＋ 3 disease, 7 （31.8%） men developed biopsy progression including 3 men （13.6%） who developed Gleason 3 ＋ 4 PCa. Of 6 men with Gleason 3 ＋ 4 disease at baseline, 2 （33.3%） men developed an increase in tumor volume, and none developed upgrading beyond Gleason 3 ＋ 4. All 96 men in the no-T group had Gleason 3 ＋ 3 disease at baseline and, 43 （44.7%） developed biopsy progression, including 9 men （9.38%） with upgrading to Gleason 7 （3 ＋ 4）. Biopsy progression rates were similar for both groups and historical controls. Biopsy progression in men on AS appears unaffected by T therapy over 3 years. Prospective placebo-controlled trials of T therapy in T-deficient men on AS should be considered given the symptomatic benefits experienced by treated men.