Long-Term Testosterone Therapy Does Not Increase the Risk of Prostate Cancer
New study in the Journal of Urology® analyzed results from three independent
New study in the Journal of Urology® analyzed results from three independent registries
Testosterone(T) therapy is routinely used in men with hypogonadism, a condition in whichdiminished function of the gonads occurs. Although there is no evidence that Ttherapy increases the risk of prostate cancer (PCa), there are still concernsand a paucity of long-term data. In a new study in The Journal of Urology®, investigators examined threeparallel, prospective, ongoing, cumulative registry studies of over 1,000 men.Their analysis showed that long-term T therapy in hypogonadal men is safe anddoes not increase the risk of PCa.
Leadinvestigator Ahmad Haider, MD, PhD, urologist, Bremerhaven, Germany, states,"Although considerable evidence exists indicating no relationship betweentestosterone and increased risk of developing PCa, decades of physiciantraining with the notion that testosterone is fuel for PCa made it difficult todispel such fallacy and the myth continued to persist. Nevertheless, in theabsence of long-term follow-up data demonstrating reduced risk of PCa inhypogonadal men who are receiving T therapy, considerable skepticism remainsthroughout the medical community and this is an expected natural and acceptablepath of medical and scientific discourse. In view of the current evidence,clinicians are compelled to think this over and cannot justify withholding Ttherapy in hypogonadal men, also in men who have been successfully treated forPCa."
Atotal of 1,023 patients on T therapy were followed for up to 17 years with amedian follow-up of approximately 5 years. Two study cohorts of 261 (cohort 1)and 340 (cohort 2) men were treated by urologists since 2004 and a third cohortof 422 men was treated at an academic andrology center since 1996. Hypogonadismwas diagnosed if testosterone was ≤12 nmol/L and if other symptoms werepresent, such as erectile dysfunction, fatigue, depression, or unfavorablechanges in body composition (gaining of fat mass and waist circumferencedespite physical activity). If no contraindications were present, all werestarted on T therapy.
There were six (2.3%) diagnosesof PCa in cohort 1, there were five (1.5%) diagnoses of PCa in cohort 2, andall biopsies were negative in cohort 3. PCa incidence per 10,000 patient-yearsin cohorts 1 and 2 was 54.4 and 30.7, respectively, which is lower than 116reported by the PLCO (Prostate, Lung, Colorectal, and Ovarian Cancer ScreeningTrial) and 96.6 reported by the ERSPC ( European Randomized Study of Screeningfor Prostate Cancer).
Investigatorsstress that if guidelines for T therapy are properly applied, it is safe inhypogonadal men.
Notes for editors
"Incidenceof Prostate Cancer in Hypogonadal Men Receiving Testosterone Therapy:Observations from Five Year-median Follow-up of Three Registries," by AhmadHaider, Michael Zitzmann, Gheorghe Doros, Hendrik Isbarn, Peter Hammerer, andAksam Yassin. DOI: http://dx.doi.org/10.1016/j.juro.2014.06.071. The Journal of Urology®,Volume 193/Issue 1 (January 2015) by Elsevier.
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