Can testosterone therapy be offered to men on active surveillance for prostate cancer? Preliminary results.

This report presents our experience with T therapy in a cohort of T-deficient men on active surveillance (AS) for Gleason 3 + 3 and Gleason 3 + 4 prostate cancer (PCa). A retrospective chart review identified 28 men with T deficiency who underwent T therapy (T group) for at least 6 months while on AS for PCa.

A comparison group of 96 men on AS for PCa with untreated T deficiency (no-T group) was identified at the same institution. The AS protocol followed a modified Epstein criteria and allowed inclusion of men with a single core of low-volume Gleason 3 + 4 PCa. Mean age was 59 5 and 61 3 years, and mean follow-up was 38 9 and 42 4 months for the T and no-T groups, respectively. Of all 28 men in the T group, 3 (10 7%) men developed an increase in Gleason score while on AS. Of 22 men in the T group with Gleason 3 + 3 disease, 7 (31 8%) men developed biopsy progression including 3 men (13 6%) who developed Gleason 3 + 4 PCa Of 6 men with Gleason 3 + 4 disease at baseline, 2 (33 3%) men developed an increase in tumor volume, and none developed upgrading beyond Gleason 3 + 4 All 96 men in the no-T group had Gleason 3 + 3 disease at baseline and, 43 (44 7%) developed biopsy progression, including 9 men (9 38%) with upgrading to Gleason 7 (3 + 4). Biopsy progression rates were similar for both groups and historical controls. Biopsy progression in men on AS appears unaffected by T therapy over 3 years. Prospective placebo-controlled trials of T therapy in T-deficient men on AS should be considered given the symptomatic benefits experienced by treated men.

Asian journal of andrology 2015 Aug 21 [Epub ahead of print]

Ravi Kacker, Hult Mariam, Ignacio F San Francisco, William P Conners, Pablo A Rojas, William C Dewolf, Morgentaler Abraham

Men's Health Boston, Brookline, MA, USA