Testosterone does not induce biochemical recurrence in men after RP

Select men who underwent radical prostatectomy (RP) for organ-confined prostate cancer may safely use testosterone therapy, which does not seem to cause biochemical recurrence (BCR), according to a study. 

A total of 5,199 men who underwent RP and had grade groups 1 to 3 on RP pathology were included in the analysis. Researchers used a Cox model for time to BCR, with testosterone use included as a time-dependent covariate, adjusted for age, preoperative prostate-specific antigen (PSA), grade group at RP, and the presence of comorbidities. 

A landmark analysis was performed, including patients whose last PSA in the 18 weeks after the procedure was undetectable and had not had BCR or been lost to follow-up by that point. Follow-up for BCR started at 18 weeks. BCR was characterized by a PSA ≥0.1 ng/mL following RP with a second confirmatory rise ≥0.1 ng/mL. 

Of the participants, 198 (median age 59 years) received testosterone at any point after RP, and 5,001 (median age 61 years) did not. 

Men who received testosterone therapy were more likely to present with more vascular comorbidities. In this group, 49 percent were prescribed clomiphene citrate, 32 percent received transdermal testosterone, and 19 percent received intramuscular testosterone. 

The use of testosterone after RP correlated with a decreased risk of BCR, but this did not reach statistical significance (hazard ratio, 0.84, 95 percent confidence interval, 0.48–1.46; p=0.5). In addition, the overall rates of BCR were low, with a probability of BCR <2 percent at 5 years in both groups.