Long-Term Exposure to Testosterone Therapy and the Risk of High-Grade Prostate Cancer

PURPOSE - No population-based studies have examined whether long-term exposure to testosterone therapy is associated with an increased risk of high-grade prostate cancer. In this study, we examined whether exposure to testosterone over a 5-year period was associated with an increased risk of high-grade prostate cancer and whether this risk increased in a dose-response fashion with cumulative number of testosterone injections.

MATERIALS AND METHODS - Using SEER-Medicare linked data, we identified 52,579 men who were diagnosed with incident prostate cancer between January 1, 2001 and December 31, 2006 and who had a minimum of 5 years continuous enrollment in Medicare before their cancer diagnosis. We excluded patients who were diagnosed at death or after autopsy, enrolled in a health maintenance organization in the 60 months before diagnosis, or had unknown tumor grade or tumor stage. In the 5 years before their diagnosis, 574 men had a history of testosterone use and 51,945 did not.

RESULTS - Using logistic regression adjusting for demographic and clinical characteristics, exposure to testosterone therapy was not associated with an increased risk of high-grade prostate cancer (OR 0.84, 95% CI 0.67-1.05) or receipt of primary ADT following diagnosis (OR 0.97, 95% CI 0.74-1.30). In addition, the risk of high-grade disease did not increase according to total number of testosterone injections (OR 1.00, 95% CI 0.98-1.01).

CONCLUSIONS - Our finding that testosterone therapy was not associated with an increased risk of high-grade prostate cancer may provide important information regarding the risk-benefit assessment for men with testosterone deficiency considering treatment.

J Urol. 2015 Jun 8. pii: S0022-5347(15)04148-8. doi: 10.1016/j.juro.2015.05.099. [Epub ahead of print]

Baillargeon J1, Kuo YF2, Fang X3, Shahinian VB4.

1 Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas; Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
2 Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas; Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas.
3 Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.
4 Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (VBS).