Wednesday, November 12, 2008

A Rational Approach to Androgen Therapy for Hypogonadal Men with Prostate Cancer

J Kaufman

Int J Impot Res. 2006;18(1):26-31. ©2006 Nature Publishing Group


With earlier detection and improved survival from early stage prostate cancer, it is likely that the numbers of men presenting with hypogonadal symptoms following curative surgery for their cancer will increase. Although testosterone supplementation is effective in improving symptoms of hypogonadism, traditionally such therapy has been contraindicated in patients who have had prostate cancer. This paper reviews the evidence that testosterone therapy can be safely given to selected men with hypogonadism who have had prostate cancer but currently have no evidence of disease by clinical and prostate-specific antigen (PSA) criteria. Such patients should be treated cautiously and followed closely.

Table 2. Recommendations for Testosterone Replacement Therapy After Curative Treatment for Prostate Cancer

  • Restrict to symptomatic hypogonadal men with
    • favorable pretreatment disease and pathologic staging
    • undetectable PSA (or <>
  • Discuss pros and cons with patient and get informed consent
  • Testosterone replacement therapy should be delayed after curative treatment for prostate cancer until undetectable PSA levels are confirmed
  • Testosterone levels under treatment should be in the low normal range
  • Monitoring should be performed every 3-6 months for the first year, then yearly thereafter, including the following procedures
    • PSA
    • Digital rectal exam
    • Serum testosterone


  1. Should the routine exam involve hemoglobin?
    Also, should we draw peak or trough testosterone?

  2. My assumption would be: draw a peak testosterone as it's the higher levels of testosterone which could potentially spur prostate ca growth.

    They were specifically addressing the controversy regarding testosterone therapy in males treated for prostate cancer. I assume that they implied that all of the usual things that we monitor and follow with testosterone therapy apply.

  3. How long after completion of treatment for prostate cancer do you have to wait before giving the testosterone?

  4. Good question.

    From the article:
    "recent data suggest that this recommendation [to give testosterone] can be modified in select cases, that is, when cancer is undetectable and the patient has documented hypogonadism."

    My feeling is you must feel pretty darn sure that the cancer is truly gone and the patient really needs/wants testosterone. The patient that I'm seeing has had an undectable ultrasensitive PSA for > 10 years, low testosterone (around 15); he is very tired, and would still like testosterone when explained all of the risks.


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