STOCKHOLM, SWEDEN (UroToday.com) - Dr. G.R. Dohle presented a snapshot of the EAU guidelines on testosterone supplementation and prostate cancer at the 2014 EAU meeting in Stockholm. Among middle-aged men, the incidence of hypogonadism is estimated at approximately 6%. Androgen deficiency increases with age at a rate of 0.4-2.0% per year. Testosterone replacement therapy is used to ameliorate symptoms in hypogonadal men, increase weight reduction, and improve diabetes control and bone mineralization. However there are a number of potential side effects of testosterone supplementation, the most worrisome of which is stimulation of prostate growth.
There is unequivocal evidence that testosterone can stimulate growth and aggravate symptoms in men with locally advanced and metastatic prostate cancer (level 2/grade A). However there is no conclusive evidence that testosterone therapy increases the risk of developing prostate cancer (PCa) or that it can convert subclinical PCa to detectable disease (level 4/Grade C). While no direct association between testosterone and the risk for prostate cancer has been demonstrated, men with Klinefelter syndrome have a lower mortality risk for prostate cancer as compared to the general population. A meta-analysis of studies on testosterone replacement therapy revealed a non-statistically significant increase in the incidence of PCa.
Dr Dohle then went on to discuss the role of testosterone replacement therapy following radical prostatectomy. Current evidence reveals no increase in the risk of recurrence, but data are limited. Androgen receptor stimulation is already maximal just slightly above castration levels, and additional testosterone will not increase growth. The guidelines recommend an overall assessment of hematological, cardiovascular, and PCa risk prior to initiation of testosterone replacement therapy. Testosterone replacement should not be instituted for at least one year following radical prostatectomy. While no studies, to date, have shown an increased risk for PCa associated with testosterone replacement therapy, longer follow-up data and more studies are needed to definitively assess the risks associated with testosterone replacement.
Presented by G.R. Dohle at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden
Erasmus University, Rotterdam (NL)
Written by Jeffrey J. Tomaszewski, MD, medical writer for UroToday.com