Testosterone supplementation after prostatectomy – journey from bad to good
Reviewed by Karthik Rajan

The role of androgens in the pathogenesis of prostate cancer is quite complex and is not entirely clear yet. Despite several reports suggesting testosterone use is safe in patients diagnosed with prostate cancer, many clinicians are still reluctant to use it even if patients have low testosterone levels. This study has evaluated patients requiring testosterone supplementation (TRT) long-term after radical prostatectomy and compared them to a well-matched cohort of patients not on testosterone therapy (control). They have compared both the rates of biochemical recurrence (BCR) and effect on sexual function recovery. Overall, 152 patients were in the TRT group and 419 patients in the control group. The patients were followed-up for a median duration of 3.5 years. In the TRT group 7.2% of patients had BCR which was significantly lower than the 12.6% rates of BCR seen in the control group. They also predicted that TRT reduced the likelihood of BCR by 54% and delayed the time to recurrence by an average of 1.5 years. Ninety-six percent of men in the TRT group seem to have recovered sexual function at two years, however, the same data for the control group is not available. The majority of the patients in both groups (79 in TRT vs. 78.8 in control) belonged to either Gleason grade group 1 or 2, meaning they were probably at a lower risk of BCR anyway. This study gives a controversial outlook suggesting that postoperative testosterone supplementation may be protective against BCR for a very select group of individuals with low-risk disease. Although encouraging, these results need to be confirmed in well-designed prospective randomised control trials before any recommendations can be made.

Testosterone replacement therapy reduces biochemical recurrence after radical prostatectomy.
Ahlering T, Hyunh L, Towe M, et al.
BJU INTERNATIONAL
2020;126:91-6.