Agarwal, P., & Oefelein, M. (2005). Testosterone replacement therapy after primary treatment for prostate cancer. Journal of Urology, 173, 533–536.

The study examined estosterone replacement therapy (TRT) after primary treatment for prostate cancer for the management symptoms.

Patients were placed on topical, transdermal, or intramuscular testosterone formulations and followed at regular intervals (every two months) with determinations of serum total testosterone and prostate-specific antigen (PSA) level.

Ten men, with a mean age of 63.4 years, were enrolled.  Participants were identified between 1993 and 2003, had no evidence of disease by clinical and PSA criteria. They presented postoperatively with complaints of decreased libido, erectile dysfunction, lack of energy, cognitive impairment, or hot flashes.

The study was a retrospective case review of patients with organ-confined prostate cancers that were subsequently treated for hypogonadism with testosterone replacement therapy.

At each two month visit, the participants completed the hormone domain of the Extended Prostate Inventory Composite (EPIC) Health-Related QOL questionnaire without any assistance form a healthcare provider.

Median duration of treatment was 19 months. During the course of therapy, no patient had a PSA recurrence. The hormone domain of the EPIC questionnaire increased significantly from 38 to 49, primarily due to a reduction in hot flashes and an increase in energy level.

A few case reports suggest that short-term TRT can cause an increase in PSA and convert an occult lesion into a clinically apparent one.

Baseline serum PSA and digital rectal examination must be performed along with baseline serum free and total testosterone. Also patients must be followed frequently, especially if baseline prostate biopsy is not performed. A large placebo-controlled, multicenter prospective trial to evaluate the feasibility of TRT in patients with hypogonadism after radical prostatectomy is indicated.