The absolute contraindication for testosterone administration in hypogonadal men with prostate cancer has been questioned, and under certain circumstances such as successfully treated prostate cancer or active surveillance for low-risk disease, testosterone administration is warranted, though definitive guidelines are unavailable.
Key Findings
Background
The traditional absolute contraindication for testosterone therapy in hypogonadal men with prostate cancer has been increasingly questioned by professional associations.
Some professional associations still adhere to traditional concepts prohibiting testosterone use in prostate cancer patients.
There is described as 'increasing relaxation' of these absolute contraindication positions.
The paper characterizes current evidence as 'incomplete but best attainable information' insufficient for definitive guidelines.
Conclusions
Testosterone administration is considered warranted in hypogonadal men with successfully treated prostate cancer or those on active surveillance for low-risk disease.
Two specific clinical circumstances are identified as appropriate for testosterone therapy consideration: successfully treated prostate cancer and active surveillance for low-risk disease.
The benefits must 'heavily outweigh the hazards' when considering testosterone therapy in these populations.
The paper recommends competent initial assessment of individual circumstances and mandatory follow-up.
Conclusions
Extreme caution is advised for testosterone therapy in men with intermediate or high-risk prostate cancer.
Men with intermediate or high-risk cancer are distinguished as a separate, higher-risk category from those with low-risk or treated disease.
Ideally, men with intermediate or high-risk cancer should participate in clinical trials and registries rather than receive testosterone therapy outside of formal study.
The paper characterizes the risk-benefit calculus differently for this group compared to low-risk or treated patients.
Background
Evidence for definitive clinical guidelines on testosterone therapy in prostate cancer patients is currently unavailable.
The paper explicitly states 'the evidence for definitive guidelines is unavailable.'
Clinicians are described as having to 'rely on incomplete but best attainable information.'
The paper is characterized as incorporating 'low-level evidence into practical recommendations,' as noted in the title.
Morales A, Siemens D. (2022). Testosterone Therapy and Prostate Cancer: Incorporating Low-Level Evidence into Practical Recommendations.. The Urologic clinics of North America. https://doi.org/10.1016/j.ucl.2022.07.002