Testosterone replacement therapy (TRT) remains controversial in men with treated prostate cancer. We assessed its safety and functional impacts in patients after definitive surgical treatment with robotic-assisted radical prostatectomy (RARP).
We performed a retrospective analysis of 1303 patients who underwent RARP during the years 2006-2019. We identified men with symptoms of andropause and low serum testosterone who received TRT post-RARP; then we divided the cohort into two groups accordingly for comparison. Biochemical recurrence (BCR) was the primary endpoint. Secondary endpoints included functional outcomes. Predictors of BCR, including the effect of TRT on BCR, were evaluated using univariable and multivariable logistic regression.
Among the forty-seven men who received TRT, the mean age was 60.83 years with a median follow-up of 48 months. Three (6.4%) and 157 (12.56%) patients experienced BCR in TRT and non-TRT groups, respectively. Baseline characteristics were similar between both groups except for higher mean BMI in the TRT group (p = 0.03). In the multivariate analysis (MVA), higher pre-RARP prostate-specific antigen (PSA) (p = 0.043), higher International Society of Urological Pathology score (p < 0.001), seminal vesical invasion (p = 0.018) and positive surgical margin (p < 0.001) were predictors of BCR. However, TRT was not (p = 0.389). In addition, there was a significant change in the Sexual Health Inventory for Men (p = 0.022), and serum testosterone level (p < 0.001) before and 6 months after initiation of TRT.
Our findings suggest that TRT, in well-selected, closely followed, symptomatic men post-RARP is an oncologically safe and functionally effective treatment in prostate cancer patients post-RARP.
World journal of urology. 2020 Oct 09 [Epub ahead of print]
Hanna Shahine, Marc Zanaty, Ahmed S Zakaria, David-Dan Nguyen, Felix Couture, Iman Sadri, Russel Schwartz, Adel Arezki, Dean Elterman, Assaad El-Hakim, Kevin C Zorn
Département d'Urologie, Robotic Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada., Department of Urology, Hopital Rouyn-Noranda, Quebec, Canada., Faculty of Medicine, McGill University, Montreal, Canada., Département d'Urologie, Centre Hospitalier de l'Université de Sherbrooke, Montreal, Canada., School of Medicine, McGill University, Montreal, Canada., Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada., Hopital du Sacre-Coeur de Montreal, Montreal, QC, Canada., Département d'Urologie, Robotic Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada. .