- Design
- Retrospective single-centre cohort
- Population
- 3,324 men with GG1–2 prostate cancer on active surveillance, 79 on testosterone
- Primary outcome
- Time to grade group progression on biopsy
- Effect
- HR 0.99 (95% CI 0.67 to 1.48)
A single-centre US review included 3,324 men with grade group 1 or 2 prostate cancer on active surveillance, 79 of whom were also on testosterone therapy. Surveillance included examination and bloods every six months, MRI every 18 months and biopsy every 36 months.
38% progressed on biopsy overall. Testosterone therapy was not associated with biopsy progression (HR 0.99, 0.67 to 1.48) or with moving to definitive treatment (HR 0.94, 0.64 to 1.38).
This adds to the case that symptomatic hypogonadism need not be left untreated in men on surveillance. With only 79 treated men, however, the confidence interval allows up to a 48% higher risk.
- Confirm symptomatic hypogonadism with two morning testosterone levels before treating.
- Discuss the uncertain evidence and document shared decision-making.
- Check PSA 2 to 4 weeks after starting and then six-monthly.
- Keep to the full surveillance schedule, including MRI and biopsy.
Why it matters
It challenges the reflex to withhold testosterone from every man with prostate cancer.
Don't overread it
Only 79 men received testosterone; the interval does not exclude a meaningful increase in risk.
The statistics, in plain English
An HR of 0.99 means no difference on average, but the interval runs from a 33% lower to a 48% higher risk. That width comes from the small treated group. Men chosen for testosterone may also have been judged lower-risk.
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