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Testosterone replacement therapy reduces biochemical recurrence after radical prostatectomy
Author(s) -
Ahlering Thomas E.,
My Huynh Linda,
Towe Maxwell,
See Kaelyn,
Tran Joshua,
Osann Kathryn,
el Khatib Farouk M.,
Yafi Faysal A.
Publication year - 2020
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.15042
Subject(s) - medicine , urology , testosterone (patch) , biochemical recurrence , hazard ratio , prostatectomy , prostate cancer , confidence interval , proportional hazards model , prostate specific antigen , stage (stratigraphy) , sex hormone binding globulin , univariate analysis , sexual function , multivariate analysis , cancer , hormone , androgen , paleontology , biology
Objective To evaluate risk of prostate cancer biochemical recurrence (BCR) after radical prostatectomy (RP) in men receiving vs not receiving testosterone replacement therapy (TRT). Patients and Methods A total of 850 patients underwent RP by a single surgeon. All patients had preoperative testosterone and sex hormone‐binding globulin levels determined; free testosterone was calculated prospectively. In all, 152 (18%) patients with low preoperative calculated free testosterone (cFT) levels and delayed postoperative sexual function recovery were placed on TRT and proportionately matched to 419 control patients by pathological Gleason Grade Group (GGG) and stage. Rates and time to BCR [two consecutive prostate‐specific antigen (PSA) levels of ≥0.2 ng/mL] were compared in univariate and multivariate regression; Cox regression was used to generate a survival function at the mean of covariates. Results The median follow‐up was 3.5 years. There were no statistically significant differences in demographics or general health complications between groups. BCR occurred in 11/152 (7.2%) and 53/419 (12.6%) patients in the TRT and control groups, respectively. In adjusted time‐to‐event analysis, TRT was an independent predictor of recurrence‐free survival. After accounting for GGG, pathological stage, preoperative PSA level, and cFT, patients on TRT were ~54% less likely to recur (hazard ratio 0.54, 95% confidence interval 0.292–0.997). In men destined to recur, TRT delayed time to recurrence by an average of 1.5 years. Conclusion In our experience, TRT after RP significantly reduced BCR and delayed time to BCR. There was no identifiable general health complications associated with TRT. These findings are hypothesis‐generating and require confirmation with multi‐centred, prospective randomised controlled trials.