A population-based study showed no association between total prostate cancer risk and testosterone replacement therapy (TRT), though the study also showed that men who received TRT for over a year had a decreased risk of aggressive prostate cancer.1
In a nested, case-control study, the investigators analyzed the National Prostate Cancer Registry of Sweden, which included 38,570 prostate cancer cases and 192,838 age-matched men without prostate cancer. Of these, 284 of patients and 1378 control cases filled prescriptions for TRT.
With an estimated odds ratio (OR) of 1.03, “no significant difference was found in prostate cancer risk on the basis of TRT exposure,” the investigators noted. Risk for prostate cancer was also not significant based on route of administration of TRT-gel vs other forms.
No difference in prostate cancer risk was reported based on timing or duration of TRT, suggesting that TRT does not promote prostate cancer.
Men who received TRT had a more favorable-risk prostate cancer (OR, 1.35) and a lower risk of aggressive prostate cancer (OR, 0.50).
The authors noted that men with testosterone deficiency (ie, hypogonadism) have several health issues, such as increased risk for bone fracture, poor quality sleep, and fatigue. Since 2011, however, there has been a decline in TRT usage due to factors including changes in insurance coverage and the ongoing debate on its risks (cardiac and prostate cancer risk) and benefits.
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“The findings [of this study] suggest that from a prostate cancer perspective, TRT is safe in hypogonadal men,” the authors concluded.
Loeb S, Folkvaljon Y, Damber JE, Alukal J, Lambe M, Stattin P. Testosterone replacement therapy and risk of favorable and aggressive prostate cancer. J Clin Oncol. 2017 Mar 13. doi: 10.1200/JCO.2016.69.5304 [Epub ahead of print]