Can Testosterone Replacement Therapy Lower the Risk of A Recurrence?

In a surprising study, researchers at the University of California, Irvine, led by Professor Thomas Ahlering found that in a sample of carefully selected men who had low-risk prostate cancer and who had surgery, testosterone replacement therapy significantly lowered their risk for having a prostate cancer recurrence! 

This finding directly contradicts the commonly held belief that testosterone promotes prostate cancer and should not be used in men with a history of prostate cancer.  

The study evaluated 834 men undergoing radical prostatectomy. One hundred and fifty-two (152) low-risk men with no evidence of disease were given testosterone replacement therapy. After a median of 3.1 years following surgery, the men were evaluated for a biochemical recurrence of their cancer, as indicated by measurement of the Prostate Specific Antigen (PSA) levels. 

They found that cancer had recurred in approximately 5% of treated men, whereas cancer had recurred in 15% of the men who did not receive testosterone. Overall, after accounting for differences between the groups, they found nearly a three-fold reduction by three years.

Thomas Ahlering, the principal investigator, said, "This is not what we set out to prove, so it was a big surprise: not only did testosterone replacement not increase recurrence, but it lowered recurrence rates. While the testosterone is not curing the cancer per se, it is slowing the growth of the cancer, giving an average of an additional 1.5 years before traces of cancer can be found. We already know that testosterone can help with physiological markers such as muscle mass, better cholesterol and triglyceride levels, and increased sexual activity, so this seems to be a win-win".

He also said, "There have been smaller studies which have hinted that testosterone may not be risky for certain patient groups, but this is the largest such study ever conducted. We're not suggesting that treatment methods be changed just yet, but this puts us at the stage where we need to question the taboo against testosterone use in prostate cancer therapy—especially for low-risk patients after radical prostatectomy. We need the oncology/urology community to begin to review testosterone use".

This study is fascinating, but additional controlled studies remain to be performed.  Additionally, we would note that the selection of candidates for hormone replacement therapy needs to be done very carefully and that a longer-term study would also prove additional confidence.