Study: Prostate Cancer Risk Not Increased by Testosterone Therapy

Concerns still remain, however, and there is a lack of long-term data.

Testosterone therapy was not found to increase the risk of prostate cancer in a recent study, however concerns remain and there is still a dearth of long-term data.

In a study published last week in The Journal of Urology, researchers analyzed 3 current parallel, prospective, cumulative registry studies that included more than 1000 men. The researchers found that long-term testosterone therapy in hypogonadal men is safe and the risk of developing prostate cancer is not increased.

"Although considerable evidence exists indicating no relationship between testosterone and increased risk of developing prostate cancer, decades of physician training with the notion that testosterone is fuel for prostate cancer made it difficult to dispel such fallacy and the myth continued to persist,” lead investigator Ahmad Haider, MD, PhD, said in a press release. “Nevertheless, in the absence of long-term follow-up data demonstrating reduced risk of prostate cancer in hypogonadal men who are receiving testosterone therapy, considerable skepticism remains throughout the medical community and this is an expected natural and acceptable path of medical and scientific discourse.”

The study followed 1023 patients on testosterone therapy for up to 17 years with a median follow-up of approximately 5 years. Cohort 1 included 261 men and cohort 2 included 340 men, all of whom were treated by urologists since 2004. A third cohort of 422 men received treatment at an academic andrology center since 1996.

A diagnosis of hypogonadism was made if testosterone was ≤12 nmol/L. It was also diagnosed in the presence of other symptoms, including erectile dysfunction, fatigue, depression, or unfavorable changes in body composition, such as increased fat mass and waist circumference despite physical activity, the study noted.

If there were no contraindications, the patient was started on testosterone therapy.

There were 6 prostate cancer diagnoses in cohort 1, there were 5 in cohort 2, and all biopsies were negative in cohort 3. Prostate cancer incidence per 10,000 patient-years in the first 2 cohorts were 54.4 and 30.7, respectively.

That rate is lower than the 116 reported by the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and 96.6 reported by the European Randomized Study of Screening for Prostate Cancer.

“In view of the current evidence, clinicians are compelled to think this over and cannot justify withholding testosterone therapy in hypogonadal men, also in men who have been successfully treated for prostate cancer,” Dr. Haider said.