Over the past 80 years there has been concern that testosterone therapy (TTh) may increase the risk of developing prostate cancer. However, over the past 15 years there has been a drastic paradigm shift in this belief. While TTh was originally thought to be dangerous, there is emerging data to suggest that TTh may be safe, therapeutic and even protective against the development and/or recurrence of prostate cancer. Recent studies have administered high doses of TTh to treat metastatic prostate cancer. In addition, other studies have found that men on TTh are less likely to have a biochemical recurrence after prostatectomy. Finally, initial studies have not demonstrated any increased risk of prostate cancer progression in hypogonadal men on TTh and active surveillance. In fact, low serum testosterone has been shown to be an independent risk factor for prostate cancer progression in men on active surveillance. It is important to realize that we do not currently have any randomized placebo controlled trials assessing the risk of TTh in men with a history of prostate cancer.
Mohit Khera, MD: Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Suite 10 B, Houston, TX 77030, USA