AB007. Testosterone and radiotherapy for prostate cancer

Objective: To critically review the literature on testosterone supplementation in patients with prostate cancer treated with radiotherapy.

Methods: Literature search, review of papers and abstracts published in English.

Results: Androgen manipulation remains an effective treatment for metastatic prostate cancer and a commonly used adjuvant treatment for locally advanced prostate cancer, in combination with external-beam radiotherapy with curative intention. Concerns on the use of testosterone in hypogonadal men with a history of prostate cancer have dominated the oncology literature of the last years and are now progressing to sexual medicine as well. Testosterone supplementation is in general considered a contraindication in men who has been previously treated for prostate cancer. Though both oncologists and sexual medicine specialists are asked by patients who have been treated for prostate cancer and who are hypogonadal be helped for their libido decrease and erectile dysfunction. So far, the reports published in peer-reviewed literature showed no biochemical recurrence in more than 74 patients after surgery and no recurrence in 36 patients after radiation (both external-beam radiotherapy and brachytherapy).

Conclusions: Although caution must be exercised in drawing conclusions from the limited clinical experience of testosterone replacement therapy after treatment prostate cancer, testosterone does not seem to be an absolute contraindication in hypogonadal patients after radiotherapy. The available literature strongly suggests that testosterone neither increases the risk of prostate cancer diagnosis in normal men nor causes cancer recurrence in men who were successfully treated for prostate cancer. A practical approach can be to inform the patients that the risk of prostate cancer progression or recurrence is unknown and an informed consent document should be provided for testosterone replacement in patients previously treated for prostate cancer.

Keywords: Prostate cancer; external-beam radiotherapy; brachytherapy; testosterone supplementation