Testosterone Replacement for Hypogonadism After Treatment of Early Prostate Cancer With Brachytherapy.

Sarosdy MF:
Cancer; 2007; 109 (February 1): 536-541

Objective: Currently, there is controversy regarding the role of testosterone replacement therapy (TRT) for hypogonadism after treatment for early, localized prostate cancer. The purpose of this study was to assess the risk of biochemical failure with TRT after treatment of localized prostate cancer with permanent transperineal brachytherapy with or without external beam therapy (EBT) in men low serum testosterone levels and symptomatic hypogonadism. Methods: A retrospective review of men who underwent brachytherapy for localized prostate cancer (1996 to 2004) and received subsequent TRT for symptomatic hypogonadism was performed. Data analyzed included tumor characteristics and treatment as well as pre- and post-TRT serum testosterone and prostate-specific antigen (PSA) values. Results: In total, 31 men received TRT after prostate brachytherapy for a median of 4.5 years (range, 0.5 to 8.5 years) with a follow-up after treatment of 5 years (range, 1.5 to 9.0 years) post-brachytherapy. TRT was started from 0.5 years to 4.5 years (median, 2.0 years) after brachytherapy. Total serum testosterone levels ranged from 30 ng/dL to 255 ng/dL (median, 188 ng/dL) before TRT and rose to 365 ng/dL to 1,373 ng/dL (median, 498 ng/dL) on TRT. Only a single patient had a transient rise in PSA. The most recent PSA level was <0.1 ng/mL in 23 patients (74.2%), <0.5 ng/mL in 30 patients (96.7%), and <1 ng/mL in 31 patients (100%). No patients stopped TRT because of cancer recurrence or documented progression. Conclusions: For patients with low serum testosterone levels and symptoms of hypogonadism, TRT may be used with caution and close follow-up after prostate brachytherapy.Reviewer’s Comments: Controversy exists regarding the risk of TRT in men who are at risk for the development of prostate cancer. Even more so, there is concern over the progression of cancer among men with a diagnosis of prostate cancer on androgen replacement therapy. So, one question that arises is what to do in terms of androgen replacement once a man with symptomatic hypogonadism has been treated for localized prostate cancer. This study looked at the impact of TRT among men with symptomatic hypogonadism who were treated for early stage, clinically localized prostate cancer. Specifically, this study addressed men on TRT after treatment with brachytherapy. The author found that among the 31 men treated with brachytherapy followed for a median of 5 years, there did not appear to be any significant negative impact on cancer control despite the TRT. In fact, no patients stopped TRT because of cancer recurrence. As noted by the authors, careful patient selection, close monitoring, and vigilant long-term follow-up are essential ingredients to ensure there is no compromise in cancer control. (Reviewer–Michael S. Cookson, MD).