bance, osteoporosis and loss of muscle strength, LOH has
widespread implications on men’s health and has been asso-
ciated with cardiovascular disease, insulin resistance, type II
diabetes and metabolic syndrome.
3–6
Treatment with testosterone replacement therapy (TRT) ame-
liorates the symptoms of hypogonadism, but is controversial in
the setting of prostate cancer (CaP) due to the belief that T can
stimulate its growth. A study by Huggins and Hudges
7
in 1941
demonstrated CaP regression in men with metastatic disease after
surgical castration and subsequent
in vitro
studies showed CaP cell
growth after treatment with T, further supporting the CaP–androgen
relationship.
8
Despite these early ±ndings, there remains a dearth
of clinical evidence supporting a link between high serum T and
increased CaP risk. Thus, in the light of mounting evidence sug-
gesting worse health outcomes in men diagnosed with hypogo-
nadism, together with the lack of data supporting a clinical
association between T and CaP growth, TRT has been initiated in
hypogonadal men with CaP.
Most studies examining hypogonadal men receiving TRT after
radical prostatectomy (RP) have described no cases of biochemical
recurrence or evidence of CaP progression in the setting of
localized disease.
9–11
Similarly, studies of patients with CaP treated
with brachytherapy and/or external beam radiotherapy (EBRT) and
on TRT have reported transient rises in prostate-speci±c antigen
(PSA), but no patients with CaP recurrence or progression
prompting TRT cessation.
12–14
Furthermore, no evidence of bone
metastasis or local recurrence has been observed in hypogonadal
patients with locally advanced CaP who underwent surgical
castration followed by intermittent TRT, nor have there been
signi±cant rises in PSA or evidence of CaP progression in patients
with CaP on active surveillance treated with TRT.
15,16
In one study
examining 96 men on TRT after RP, radiation therapy, or
intermittent androgen deprivation, with 8 men demonstrating
evidence of distant metastasis prior to TRT initiation, TRT was
stopped in 60% of men due to rising PSA.
17
The above small studies overall support the use of TRT in
patients with CaP, irrespective of CaP treatment modality, in the
setting of vigilant follow-up, as does a recent review of the pub-
lished literature, particularly given the known effects of exogenous
T on prostate cell growth
in vitro
.
18
However, no published data
from randomized controlled trials studying outcomes of TRT in
treated CaP patients are currently available, and the data from
retrospective studies are limited. In this retrospective study, we
assess the ef±cacy and safety of TRT in a cohort of men with CaP
treated with radiation, with the goal of adding to the literature
describing TRT in men with CaP.
1
Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA;
2
Baylor College of Medicine, Houston, TX, USA and
3
Methodist Urology Associates, The Methodist
Hospital, Houston, TX, USA. Correspondence: M Khera, Scott Department of Urology, Baylor College of Medicine, 6620 Main Street, Suite 1325, Houston, TX 77030, USA.
E-mail: mkhera@bcm.edu
4
These authors contributed equally to this work.
Received 23 January 2012; revised 5 June 2012; accepted 13 July 2012; published online 13 September 2012
International Journal of Impotence Research (2013) 25, 24–28