Testosterone treatment is not associated with increased risk of prostate cancer or worsening of lower urinary tract symptoms: prostate health outcomes in the Registry of Hypogonadism in Men.

Abstract

OBJECTIVES:

To evaluate the effects of testosterone-replacement therapy (TRT) on prostate health indicators in hypogonadal men, including rates of prostate cancer diagnoses, changes in prostate-specific antigen (PSA) levels and lower urinary tract symptoms (LUTS) over time.

PATIENTS AND METHODS:

The Registry of Hypogonadism in Men (RHYME) is a multi-national patient registry of treated and untreated, newly-diagnosed hypogonadal men (n = 999). Follow-up assessments were performed at 3-6, 12, 24, and 36 months. Baseline and follow-up data collection included medical history, physical examination, blood sampling, and patient questionnaires. Prostate biopsies underwent blinded independent adjudication for the presence and severity of prostate cancer; PSA and testosterone levels were measured via local and central laboratory assays; and LUTS severity was assessed via the International Prostate Symptom Score (IPSS). Incidence rates per 100 000 person-years were calculated. Longitudinal mixed models were used to assess effects of testosterone on PSA levels and IPSS.

RESULTS:

Of the 999 men with clinically diagnosed hypogonadism (HG), 750 (75%) initiated TRT, contributing 23 900 person-months of exposure. The mean testosterone levels increased from 8.3 to 15.4 nmol/L in treated men, compared to only a slight increase from 9.4 to 11.3 nmol/L in untreated men. In all, 55 biopsies were performed for suspected prostate cancer, and 12 non-cancer related biopsies were performed for other reasons. Overall, the proportion of positive biopsies was nearly identical in men on TRT (37.5%) compared to those not on TRT (37.0%) over the course of the study. There were no differences in PSA levels, total IPSS, or the IPSS obstructive sub-scale score by TRT status. Lower IPSS irritative sub-scale scores were reported in treated compared to untreated men.

CONCLUSIONS:

Results support prostate safety of TRT in newly diagnosed men with HG.

• Authors: Frans M J Debruyne, Hermann M Behre, Claus G Roehrborn, Mario Maggi, Frederick C W Wu, Fritz H Schröder, Thomas Hugh Jones, Hartmut Porst, Geoffrey Hackett, Olivia A Wheaton, Antonio Martin-Morales, Eric Meuleman, Glenn R Cunningham, Hozefa A Divan, Raymond C Rosen, RHYME Investigators
• Journal: BJU international (BJU Int) Vol. 119 Issue 2 Pg. 216-224 (Feb 2017) ISSN: 1464-410X [Electronic] England
• PMID: 27409523 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

Chemical References

• Testosterone
• Prostate-Specific Antigen

Topics

• Disease Progression
• Hormone Replacement Therapy (adverse effects)
• Humans
• Hypogonadism (blood, drug therapy)
• Lower Urinary Tract Symptoms (chemically induced, epidemiology)
• Male
• Middle Aged
• Prostate-Specific Antigen (blood)
• Prostatic Neoplasms (chemically induced, epidemiology)
• Registries
• Risk Assessment
• Testosterone (adverse effects, therapeutic use)