Welcome to PracticeUpdate! We hope you are enjoying temporary access to this content.
Please register today for a free account and gain full access
to all of our expert-selected content.
Already Have An Account? Log in Now
Testosterone and Prostate Cancer Risk: Favorable and Less Aggressive
abstract
This abstract is available on the publisher's site.
Access this abstract nowThe association between exposure to testosterone replacement therapy (TRT) and prostate cancer risk is controversial. The objective was to examine this association through nationwide, population-based registry data.
We performed a nested case-control study in the National Prostate Cancer Register of Sweden, which includes all 38,570 prostate cancer cases diagnosed from 2009 to 2012, and 192,838 age-matched men free of prostate cancer. Multivariable conditional logistic regression was used to examine associations between TRT and risk of prostate cancer (overall, favorable, and aggressive).
Two hundred eighty-four patients with prostate cancer (1%) and 1,378 control cases (1%) filled prescriptions for TRT. In multivariable analysis, no association was found between TRT and overall prostate cancer risk (odds ratio [OR], 1.03; 95% CI, 0.90 to 1.17). However, patients who received TRT had more favorable-risk prostate cancer (OR, 1.35; 95% CI, 1.16 to 1.56) and a lower risk of aggressive prostate cancer (OR, 0.50; 95% CI, 0.37 to 0.67). The increase in favorable-risk prostate cancer was already observed within the first year of TRT (OR, 1.61; 95% CI, 1.10 to 2.34), whereas the lower risk of aggressive disease was observed after > 1 year of TRT (OR, 0.44; 95% CI, 0.32 to 0.61). After adjusting for previous biopsy findings as an indicator of diagnostic activity, TRT remained significantly associated with more favorable-risk prostate cancer and lower risk of aggressive prostate cancer.
Additional Info
Disclosure statements are available on the authors' profiles:
Testosterone Replacement Therapy and Risk of Favorable and Aggressive Prostate Cancer
J. Clin. Oncol 2017 Mar 13;[EPub Ahead of Print], S Loeb, Y Folkvaljon, J-E Damber, J Alukal, M Lambe, P StattinAdvanced Prostate Cancer Center of Excellence
Visit our Advanced Prostate Cancer Center of Excellence for additional, in-depth coverage.
In this case–control population-based study of Swedish men, an attempt was made to evaluate the role of testosterone replacement therapy on the risk of subsequent development of prostate cancer. Common practice in the United States is to show substantial caution in the follow-up of men being treated with testosterone for the detection of prostate cancer. Despite the known relationship between testosterone support of prostate cancer growth, as well as the critical role of testosterone deprivation in advanced prostate cancer, there are few or no data to suggest that testosterone actually initiates prostate cancer. If prostate cancer was initiated by testosterone replacement therapy, we would expect to see an increase in its incidence for men receiving testosterone. Sweden is an outstanding source for population-based data on treatment effects because: 1) the baseline prevalence of prostate cancer is high; 2) the excellent follow-up is available; and 3) complete records exist for residents of the country. The researchers found no overall risk of prostate cancer, and a lower risk of aggressive prostate cancer (OR, 0.50). The increase in favorable-risk prostate cancer observed within the first year of testosterone therapy may reflect the testosterone dependence on PSA production, where increases in PSA during early treatment may allow detection of preexisting cancers. The lack of development of more aggressive cancers seen in this study is reassuring—reflecting the growing recognition that therapeutic testosterone replacement does not induce prostate cancer.