Testosterone Replacement Therapy Following the Diagnosis of Prostate Cancer: Outcomes and Utilization Trends

作者：Kaplan Alan L^*; Quoc Dien Trinh; Sun Maxine; Carter Stacey C; Nguyen Paul L; Shih Ya Chen Tina; Marks Leonard S; Hu Jim C

来源：The Journal of Sexual Medicine, 2014, 11(4): 1063-1070.

DOI：10.1111/jsm.12429

• Testosterone Replacement Therapy
• Prostate Cancer
• Late-Onset Hypogonadism
• Androgen Replacement
• Testosterone Deficiency Syndrome

IntroductionLate-onset hypogonadism may impair quality of life and contribute to metabolic and cardiovascular comorbidity in aging men. Testosterone replacement therapy is effective in treating hypogonadism. However, for the millions of men with a history of prostate cancer, exogenous testosterone has long been considered contraindicated, even though little data in such men are available. Clarification of this safety issue could allow treatment to be considered for a sizeable segment of the aging male population.
AimThe aim of this study is to examine population-based utilization and impact of testosterone replacement therapy in men with prostate cancer.
MethodsUsing linked Surveillance, Epidemiology, and End Results-Medicare data, we identified 149,354 men diagnosed with prostate cancer from 1992 to 2007. Of those, 1,181 (0.79%) men received exogenous testosterone following their cancer diagnosis. We used propensity scoring analysis to examine the effect of testosterone replacement on the use of salvage hormone therapy and overall and prostate cancer-specific mortality.
Main Outcome MeasuresWe assessed overall mortality, cancer-specific mortality, and the use of salvage hormone therapy.
ResultsFollowing prostate cancer diagnosis, testosterone replacement was directly related to income and educational status and inversely related to age (all P<0.001). Men undergoing radical prostatectomy and men with well-differentiated tumors were more likely to receive testosterone (all P<0.001). On adjusted analysis, testosterone replacement therapy was not associated with overall or cancer-specific mortality or with the use of salvage hormone therapy.
ConclusionsIn this population-based observational study of testosterone replacement therapy in men with a history of prostate cancer, treatment was not associated with increased overall or cancer-specific mortality. These findings suggest testosterone replacement therapy may be considered in men with a history of prostate cancer, but confirmatory prospective studies are needed. Kaplan AL, Trinh QD, Sun M, Carter SC, Nguyen PL, Shih YCT, Marks LS, and Hu JC. Testosterone replacement therapy following the diagnosis of prostate cancer: Outcomes and utilization trends. J Sex Med 2014;11:1063-1070.

• 出版日期2014-4