Testosterone Therapy after Radiation Therapy for Low,
Intermediate and High Risk Prostate Cancer
Alexander W. Pastuszak, Abhinav Khanna, Niraj Badhiwala,
Abraham Morgentaler,* Mariam Hult,† William P. Conners,‡
Michael F. Sarosdy,§ Christopher Yang, Rafael Carrion,
Larry I. Lipshultz
k
and Mohit Khera
{
,**
From the Scott Department of Urology (AK, MK) and Center for Reproductive Medicine, Baylor College of Medicine, Houston
(AWP, LIL) and South Texas Urology and Urologic Oncology (MFS), San Antonio, Texas, Department of Urology, Washington
University in St. Louis (NB), St. Louis, Illinois, Harvard Medical School (AM, MH, WPC), Boston, Massachusetts, and
Department of Urology, University of South Florida Morsani College of Medicine (CY, RC), Tampa, Florida
Purpose:
Limited literature exists regarding the safety of testosterone therapy in
men treated for prostate cancer. We present multi-institutional data on testosterone
therapy in hypogonadal men with prostate cancer treated with radiation therapy.
Materials and Methods:
We retrospectively reviewed the records of hypogonadal
men treated with testosterone therapy after radiation therapy for prostate
cancer at 4 institutions. Serum testosterone, free testosterone, estradiol, sex
hormone-binding globulin, prostate speciFc antigen, prostate speciFc antigen
velocity and prostate biopsy Fndings were analyzed.
Results:
A total of 98 men were treated with radiation therapy. Median age was
70.0 years (range 63.0 to 74.3) at initiation of testosterone therapy. Median
baseline testosterone was 209 ng/dl (range 152 to 263) and median baseline
prostate speciFc antigen was 0.08 ng/ml (range 0.00 to 0.33). In the cohort the
tumor Gleason score was 5 in 3 men (3.1%), 6 in 44 (44.9%), 7 in 28 (28.6%), 8 in 7
(7.1%) and 9 in 4 (4.1%). Median followup was 40.8 months (range 1.5 to 147).
Serum testosterone increased to a median of 420 ng/dl (range 231 to 711) during
followup (p
<
0.001). Overall a nonsigniFcant increase in mean prostate speciFc
antigen was observed from 0.08 ng/ml at baseline to 0.09 ng/ml (p
¼
0.05). Among
patients at high risk prostate speciFc antigen increased from 0.10 to 0.36 ng/ml
(p
¼
0.018). Six men (6.1%) met criteria for biochemical recurrence.
Conclusions:
Testosterone therapy in men following radiation therapy for
prostate cancer was associated with a minor increase in serum prostate speciFc
antigen and a low rate of biochemical recurrence.
Key Words:
prostatic neoplasms, prostatectomy, testosterone,
hormone replacement therapy, radiotherapy
Accepted for publication May 13, 2015.
Study received institutional review board approval at all participating institutions.
* Financial interest and/or other relationship with Auxilium, AbbVie, Clarus, Endo, Eli Lilly, Teso RX, Pfizer and Bayer.
†
Financial interest and/or other relationship with Men
’
s Health Boston.
‡
Financial interest and/or other relationship with Vyrix, Absorption Pharmaceutical and Auxilium.
§
Financial interest and/or other relationship with Cepheid, and Womble, Carlyle, Sandridge and Rice LLP.
k
Financial interest and/or other relationship with Current Urology Reports.
{
Financial interest and/or other relationship with Coloplast, Auxilium, Pfizer and American Medical Systems.
** Correspondence: Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge, 10th Floor, Houston, Texas 77005
(telephone: 713-798-6593; e-mail: mkhera@bcm.edu
).
Abbreviations
and Acronyms
ADT
¼
androgen deprivation
therapy
BCR
¼
biochemical recurrence
CaP
¼
prostate cancer
EBRT
¼
external beam RT
FT
¼
free T
Gl
¼
Gleason score
PIN
¼
prostatic intraepithelial
neoplasia
PSA
¼
prostate specific antigen
PSAV
¼
PSA velocity
RP
¼
radical prostatectomy
RT
¼
radiation therapy
T
¼
testosterone
TTh
¼
T therapy
0022-5347/15/1945-1271/0
THE JOURNAL OF UROLOGY
®
Ó
2015 by A
MERICAN
U
ROLOGICAL
A
SSOCIATION
E
DUCATION AND
R
ESEARCH
,I
NC
.
Vol. 194, 1271-1276, November 2015
Printed in U.S.A.
www.jurology.com
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1271