Testosterone therapy was not associated with faster progression on active surveillance

Design

Retrospective single-institution cohort

Population

3,324 men on active surveillance for GG1-2 prostate cancer; 79 on testosterone

Primary outcome

Grade group progression on biopsy

Effect

HR 0.99 (95% CI 0.67-1.48); definitive treatment HR 0.94 (0.64-1.38)

This single-institution retrospective study reviewed 3,324 men on active surveillance for grade group 1 or 2 prostate cancer at a US cancer centre, of whom 79 received testosterone therapy with PSA and testosterone monitoring. Surveillance included MRI every 18 months and biopsy every 36 months.

Overall, 38% progressed on biopsy. Testosterone therapy was not associated with grade progression (HR 0.99, 95% CI 0.67-1.48) or with moving to definitive treatment (HR 0.94, 0.64-1.38).

Men with symptomatic hypogonadism on surveillance are often refused testosterone because of long-held fears that it fuels prostate cancer. These data add to evidence that the risk is lower than assumed.

With only 79 treated men, the study cannot exclude a modest increase in risk, and the authors urge careful monitoring.

• Testosterone therapy can be discussed for symptomatic hypogonadism in men on active surveillance.
• Confirm hypogonadism with repeated morning testosterone and symptoms before starting.
• Check PSA and testosterone 2-4 weeks after starting and then every 6 months.
• Keep surveillance MRI and biopsy schedules unchanged.

Why it matters

It challenges the reflex refusal of testosterone to men with low-risk prostate cancer.

Don't overread it

Only 79 men received testosterone in this observational study, so a modest increase in progression cannot be ruled out.

The statistics, in plain English

A hazard ratio of 0.99 suggests no effect, but the interval from 0.67 to 1.48 still allows up to a 48% increase in progression. Small exposed groups give wide intervals even when the point estimate is reassuring.

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