SAN FRANCISCO—Hypogonadal men who receive testosterone replacement therapy (TRT) may have a decreased risk of prostate cancer (PCa), study findings presented at the 2018 Genitourinary Cancers Symposium suggest.
Investigators Ahmad Haider, MD, and Karim Sultan Haider, MD, in private practice in Bremerhaven, Germany, based that conclusion on a study of 792 men with a testosterone level of 350 ng/dL or less. Of these, 412 received testosterone undecanoate 1000 mg every 3 months for up to 12 years and 380 opted against receiving TRT (control group). The median follow-up was 9 years, and the total observation time covered approximately 6400 patient-years.
Eleven men in the TRT group (2.7%) were diagnosed with PCa compared with 34 men (8.9%) in the control group. The incidence of PCa was 33 cases per 10,000 person-years in the TRT group versus 108 per person-years in the control group.
At baseline, the mean age of the patients with PCa was 65.2 in the TRT group and 54.3 in the control group. All PCa diagnoses in the TRT group were made within the first 18 months of treatment initiation, whereas in the control arm, PCa was diagnosed at any time during the observation period.
In addition, results showed that PCa was less severe in the TRT group. All men in the TRT group underwent radical prostatectomy (RP). All but 1 patient had a Gleason score of 6 or less and all but 1 had a predominant Gleason score of 3. The tumor grade was G2 in all 11 patients; the tumor stage was T2a in 7 patients, T2b in 3, and T2c in 1.
In the control group, 28 patients underwent RP. In all 34 patients, the Gleason score was greater than 6. Seven patients had a Gleason score of 7, 17 had a Gleason score of 8, and 10 had a Gleason score of 9. Two men had a predominant Gleason score of 3, whereas 22 and 10 had a predominant score of 4 and 5, respectively. The tumor grade was G2 in 6 patients and G3 in 28. Tumor stage was T2c in 1 patients, T3a in 3, T3b in 13, and T3c in 17. During the observation period, no biochemical recurrences of death occurred among the PCa patients in the TRT