There has been greater acceptance for TRT in men following radical prostatectomy than radiation therapy (RT), including brachtherapy (BT), since PSA monitoring is easier after surgery.
The authors report their experience using long-lasting testosterone (T) undecanoate in symptomatic hypogonadal men following BT for prostate cancer. A total of 116 patients were followed monthly with serum PSA and total T levels for the first three months, then every 3 months for the rest of the first year, every 6 months during the second year, and annually thereafter.
Mean PSA at diagnosis was 6.6 ng/ml, with Gleason score ranging from 2+3 to 4+4. Following BT baseline mean PSA was 0.65 ng/ml and baseline mean T was 343 ng/dl. At a median follow-up of 9 months (range 3-24), all patients had clinical improvement in hypogonadism symptoms while PSA showed no significant variation (0.55 ng/ml).
Many urologists are relatively hesitant to give TRT to patients with a history of prostate cancer treated with BT, especially with a relatively long-lasting T formulation. Morgantaler and colleagues, however, did both for this cohort and did not have any patients with PSA progression at 9 months.
Although the indications for safe use of TRT in patients with a history of prostate cancer are expanding, it is important to communicate the theoretical risks with patients. The use of a validated predictive nomogram for PSA recurrence, based on a patient’s individual cancer characteristics, can be as useful tool for helping patients and physicians make informed decisions together regarding TRT in this context.
Presented by F. Balbontin, S. Moreno, and A. Morgentaler at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Doron S. Stember, MD
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