A 2020 study involving more than 800 men followed since 2004 revealed that testosterone therapy not only does not increase the risk of prostate cancer but that the detected cases are less aggressive and have a better prognosis.

The fear of prostate cancer should not automatically be a reason to deny testosterone replacement therapy in hypogonadal men, as long as proper monitoring protocols are followed and any underlying prostate disease is first ruled out.

Dr. Sánchez – Neolife Medical Team

What does the new study say?

A long-term follow-up of men with testosterone levels consistent with hypogonadism (testosterone of 350 ng/dL or 3.5 ng/mL) shows that testosterone therapy does not increase the incidence of prostate cancer — a risk historically attributed to this treatment — and, when it does occur, the tumors tend to be less aggressive than in men not receiving testosterone therapy.

What was studied and what were the findings?

A total of 428 men received testosterone therapy (T group) and 395 did not (control group, CTRL). The results are clear: only 2.8% of men treated with testosterone developed prostate cancer, compared with 11.1% in the untreated group.

Even more, in the testosterone-treated group, prostate cancer appeared only within the first 18 months of treatment, and most tumors were low grade (less aggressive). In contrast, in the untreated group, tumors tended to be more invasive and aggressive (higher Gleason scores).

Importantly, in the testosterone-treated group, no recurrences or prostate cancer–related deaths occurred, unlike the control group, where recurrences and 12 deaths were recorded during follow-up. Notably, almost all men treated with testosterone were able to resume therapy after surgery.

Conclusion: What are the implications?

Estos datos respaldan la seguridad de la terapia con testosterona en varones adecuadamente seleccionados que durante más de 30 años se ha ido demostrando (p.ej. el estudio TRAVERSE, ya comentado anteriormente en la newsletter de Julio 2024 ‘‘Cómo la TRHB puede reducir la mortalidad y el riesgo de padecer cáncer’’, disipando uno de los grandes temores en la práctica médica y abriendo la puerta a mejorar la calidad de vida de muchos hombres con seguridad y controles periódicos.

It turns out that testosterone not only appears to be safe, but may also be protective against the feared prostate cancer, as it is associated with less severe tumors when proper patient selection and follow-up are ensured.

Los estudios más recientes aportan tranquilidad: no existe una relación entre los niveles endógenos de Recent studies bring further reassurance: there is no link between endogenous testosterone levels and the development of prostate cancer. Moreover, exogenous testosterone therapy has not been shown to increase PSA levels or the risk of developing this type of cancer. In fact, contrary to what was once believed, high-grade prostate cancer has been associated with low testosterone levels in the blood (1).

To date, clinical studies have also confirmed that testosterone does not increase the risk of heart attack, and there is no evidence linking its use to a higher risk of prostate cancer—concerns that previously made physicians hesitant to prescribe this therapy. These findings align with the American Urological Association (AUA) recommendations, which since 2018 have stated that men undergoing testosterone therapy do not have a higher risk of developing prostate cancer—something these studies now strongly support.

The fear of prostate cancer should not automatically be a reason to deny testosterone replacement therapy in hypogonadal men, as long as proper monitoring protocols are followed and any hidden prostate disease is ruled out beforehand.

At Neolife, we consider it essential to inform patients that current evidence does not show an increased risk of prostate cancer associated with testosterone therapy in these contexts. We emphasize the importance of proper urological monitoring and individualized patient assessment in every case.

BIBLIOGRAPHY

(1) Raynaud, J.-P. (2009). Testosterone deficiency syndrome: Treatment and cancer risk. The Journal of Steroid Biochemistry and Molecular Biology , 114(1–2), 96–105.

(2) S. Haider, A. Haider, X. Xu, 376 Prostate Cancer (PCa) Incidence and Severity in 823 Hypogonadal Men With and Without Testosterone Therapy (TTh) in a Controlled, Observational Registry Implying 7,116 Patient-years, The Journal of Sexual Medicine, Volume 17, Issue Supplement_1, January 2020, Page S105, https://doi.org/10.1016/j.jsxm.2019.11.221