despite a diagnosis of CaP. Furthermore, our data demonstrate a
lower rate of CaP recurrence in men on TRT than the published
recurrence rate for men with CaP not treated with TRT. However,
in the continued absence of randomized controlled trial data, TRT
in patients with CaP should be undertaken with appropriate
follow-up.
CONFLICT OF INTEREST
The authors declare the following potential conflict of interest. Mohit Khera: Slate
Pharmaceuticals—consultant; Auxilium Pharmaceuticals—speaker, research support;
Merck—consultant. Larry I Lipshultz: Auxilium Pharmaceuticals—consultant, speaker,
research support; Allergan Pharmaceuticals—research support. The other authors
declare no conflict of interest.
REFERENCES
1 Araujo AB, Esche GR, Kupelian V, O’Donnell AB, Travison TG, Williams RE
et al.
Prevalence of symptomatic androgen de±ciency in men.
J Clin Endocrinol Metab
2007;
92
: 4241–4247.
2 Census UBot. Age and sex composition: 2010Census UBot: Washington, DC, 2011.
3 Society TE. The Endocrine Society.
Summary from the 2nd Annual Andropause
Consensus Meeting
Chevy Chase, MD 2001.
4 Traish AM, Guay A, Feeley R, Saad F. The dark side of testosterone de±ciency: I.
Metabolic syndrome and erectile dysfunction.
J Androl
2009;
30
: 10–22.
5 Traish AM, Saad F, Feeley RJ, Guay A. The dark side of testosterone de±ciency: III.
Cardiovascular disease.
J Androl
2009;
30
: 477–494.
6 Traish AM, Saad F, Guay A. The dark side of testosterone de±ciency: II. Type 2
diabetes and insulin resistance.
J Androl
2009;
30
: 23–32.
7 Huggins C, Hudges CV. Studies on prostatic cancer. I. The effect of castration, of
estrogen and androgen injection on serum phosphatases in metastatic carcinoma
of the prostate.
Cancer Res
1941;
1
: 293–297.
8 Arnold JT, Le H, McFann KK, Blackman MR. Comparative effects of DHEA vs tes-
tosterone, dihydrotestosterone, and estradiol on proliferation and gene expres-
sion in human LNCaP prostate cancer cells.
Am J Physiol Endocrinol Metab
2005;
288
: E573–E584.
9 Agarwal PK, Oefelein MG. Testosterone replacement therapy after primary
treatment for prostate cancer.
J Urol
2005;
173
: 533–536.
10 Kaufman JM, Graydon RJ. Androgen replacement after curative radical prosta-
tectomy for prostate cancer in hypogonadal men.
J Urol
2004;
172
: 920–922.
11 Khera M, Grober ED, Najari B, Colen JS, Mohamed O, Lamb DJ
et al.
Testosterone
replacement therapy following radical prostatectomy.
JSexMed
2009;
6
: 1165–1170.
12 Morales A, Black AM, Emerson LE. Testosterone administration to men with tes-
tosterone de±ciency syndrome after external beam radiotherapy for localized
prostate cancer: preliminary observations.
BJU Int
2009;
103
:62–64
.
13 Sarosdy MF. Testosterone replacement for hypogonadism after treatment of early
prostate cancer with brachytherapy.
Cancer
2007;
109
: 536–541.
14 Morales A. Effect of testosterone administration to men with prostate cancer is
unpredictable: a word of caution and suggestions for a registry.
BJU Int
2011;
107
:
1369–1373.
15 Ferreira U, Leitao VA, Denardi F, Matheus WE, Stopiglia RM, Netto Jr. NR. Inter-
mittent androgen replacement for intense hypogonadism symptoms in castrated
patients.
Prostate Cancer Prostatic Dis
2006;
9
: 39–41.
16 Morgentaler A, Lipshultz LI, Bennett R, Sweeney M, Avila Jr. D, Khera M.
Testosterone therapy in men with untreated prostate cancer.
J Urol
2011;
185
:
1256–1260.
17 Leibowitz RL, Dorff TB, Tucker S, Symanowski J, Vogelzang NJ. Testosterone
replacement in prostate cancer survivors with hypogonadal symptoms.
BJU Int
2010;
105
: 1397–1401.
18 Jannini EA, Gravina GL, Morgentaler A, Morales A, Incrocci L, Hellstrom WJ. Is
testosterone a friend or a foe of the prostate?
J Sex Med
2011;
8
: 946–955.
19 NCCN. Prostate Cancer 2012. http://www.nccn.org.
20 Daniell HW, Clark JC, Pereira SE, Niazi ZA, Ferguson DW, Dunn SR
et al.
Hypo-
gonadism following prostate-bed radiation therapy for prostate carcinoma.
Cancer
2001;
91
: 1889–1895.
21 Pickles T, Graham P. What happens to testosterone after prostate radiation
monotherapy and does it matter?
J Urol
2002;
167
: 2448–2452.
22 Zagars GK, Pollack A. Serum testosterone levels after external beam radiation for
clinically localized prostate cancer.
Int J Radiat Oncol Biol Phys
1997;
39
: 85–89.
23 Kinsella TJ. Effects of radiation therapy and chemotherapy on testicular function.
Prog Clin Biol Res
1989;
302
: 157–171(discussion 172–157).
24 Grigsby PW, Perez CA. The effects of external beam radiotherapy on endocrine
function in patients with carcinoma of the prostate.
J Urol
1986;
135
: 726–727.
25 Taira AV, Merrick GS, Galbreath RW, Butler WM, Lief JH, Allen ZA
et al.
Serum
testosterone kinetics after brachytherapy for clinically localized prostate cancer.
Int J Radiat Oncol Biol Phys
2012;
82
: e33–e38.
26 Tomic R, Bergman B, Damber JE, Littbrand B, Lofroth PO. Effects of external
radiation therapy for cancer of the prostate on the serum concentrations of
testosterone, follicle-stimulating hormone, luteinizing hormone and prolactin.
J Urol
1983;
130
: 287–289.
27 Miller LR, Partin AW, Chan DW, Bruzek DJ, Dobs AS, Epstein JI
et al.
Influence of
radical prostatectomy on serum hormone levels.
J Urol
1998;
160
: 449–453.
28 Lukkarinen O. Total and SHBG-bound testosterone and 5 alpha-dihydrotesto-
sterone serum concentrations in normal elderly men and patients with benign
prostatic hypertrophy before and after removal of the adenoma.
Br J Urol
1980;
52
: 377–380.
29 Ghanadian R, Puah CM, Williams G, Shah PJ, McWhinney N. Suppressive effects of
surgical stress on circulating androgens during and after prostatectomy.
Br J Urol
1981;
53
: 147–149.
30 McCullough AR, Khera M, Goldstein I, Hellstrom WJ, Morgentaler A, Levine LA.
A Multi-institutional observational study of testosterone levels after testosterone
pellet (Testopel(R)) insertion.
J Sex Med
2012;
9
: 594–601.
31 Kattan MW, Potters L, Blasko JC, Beyer DC, Fearn P, Cavanagh W
et al.
Pretreat-
ment nomogram for predicting freedom from recurrence after permanent pros-
tate brachytherapy in prostate cancer.
Urology
2001;
58
: 393–399.
32 Shipley WU, Thames HD, Sandler HM, Hanks GE, Zietman AL, Perez CA
et al.
Radiation therapy for clinically ocalized prostate cancer: a multi-institutional
pooled analysis.
JAMA
1999;
281
: 1598–1604.
33 Pollack A, Hanlon AL, Movsas B, Hanks GE, Uzzo R, Horwitz EM. Biochemical failure
as a determinant of distant metastasis and death in prostate cancer treated with
radiotherapy.
Int J Radiat Oncol Biol Phys
2003;
57
: 19–23.
34 Holzman M, Carlton Jr. CE , Scardino PT. The frequency and morbidity of local
tumor recurrence after de±nitive radiotherapy for stage C prostate cancer.
J Urol
1991;
146
: 1578–1582.
35 Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate
cancer: the saturation model and the limits of androgen-dependent growth.
Eur Urol
2009;
55
: 310–320.
36 Horwitz EM, Thames HD, Kuban DA, Levy LB, Kupelian PA, Martinez AA
et al.
De±nitions of biochemical failure that best predict clinical failure in patients with
prostate cancer treated with external beam radiation alone: a multi-institutional
pooled analysis.
J Urol
2005;
173
: 797–802.
37 Warde P, Mason M, Ding K, Kirkbride P, Brundage M, Cowan R
et al.
Combined
androgen deprivation therapy and radiation therapy for locally advanced prostate
cancer: a randomised, phase 3 trial.
Lancet
2011;
378
: 2104–2111.
38 Bachman E, Feng R, Travison T, Li M, Olbina G, Ostland V
et al.
Testosterone
suppresses hepcidin in men: a potential mechanism for testosterone-induced
erythrocytosis.
J Clin Endocrinol Metab
2010;
95
: 4743–4747.
39 Dobs AS, Meikle AW, Arver S, Sanders SW, Caramelli KE, Mazer NA. Pharmaco-
kinetics ef±cacy, and safety of a permeation-enhanced testosterone transdermal
system in comparison with bi-weekly injections of testosterone enanthate for the
treatment of hypogonadal men.
J Clin Endocrinol Metab
1999;
84
: 3469–3478.
40 Kaminetsky JC, Moclair B, Hemani M, Sand M. A phase IV prospective evaluation
of the safety and ef±cacy of extended release testosterone pellets for the treat-
ment of male hypogonadism.
J Sex Med
2011;
8
: 1186–1196.
41 Vicini FA, Shah C, Kestin L, Ghilezan M, Krauss D, Ye H
et al.
Identifying differences
between biochemical failure and cure: incidence rates and predictors.
Int J Radiat
Oncol Biol Phys
2011;
81
: e369–e375.
Testosterone replacement after radiation treatment for prostate cancer
AW Pastuszak
et al
28
International Journal of Impotence Research (2013), 24 – 28
&
2013 Macmillan Publishers Limited