Prostate-specific antigen changes in hypogonadal men treated
with testosterone replacement.
Gerstenbluth RE, Maniam PN, Corty EW, Seftel ADDepartment of
Urology, Case Western Reserve University School of Medicine, University Hospitals
of Cleveland, Cleveland Veterans Affairs Medical Center, Ohio 44124, USA. J
Androl 2002 Nov-Dec;23(6):922-6
Testosterone supplementation is commonly used as a treatment
for hypogonadal men with or without erectile dysfunction. The effect of parenteral
testosterone replacement therapy on the development or growth of prostate cancer
is unclear. We assessed the effect of this treatment on serum prostate-specific
antigen (PSA) levels and risk of prostate cancer in hypogonadal men with erectile
dysfunction. Criteria for inclusion were a normal pre-treatment PSA (<4.0
ng/mL) in conjunction with a normal digital rectal examination (DRE) or a negative
pretreatment prostate biopsy for men with either an abnormal DRE or an elevated
PSA. Patients received intramuscular injections every 2 to 4 weeks, allowing
for dose titration. In this retrospective analysis, 54 hypogonadal men with
erectile dysfunction were included, with a mean age of 60.4 years (range 42.0-76.0)
and a mean follow-up of 30.2 months (range 2.0-82.0) on testosterone therapy.
Mean pretreatment total testosterone level was 1.89 ng/mL (range 0.2-2.92),
which increased during treatment to a mean of 9.74 ng/mL (range 1.50-26.30,
P <.001). Mean pretreatment PSA was 1.86 ng/mL (median 1.01 ng/mL, range
0.0-15.80), which increased to a mean PSA level of 2.82 ng/mL (median 1.56 ng/mL,
range 0.0-32.36, P <.01) with testosterone treatment. Of the 54 men included
in this study, 6 (11.1%) required prostate biopsy while on testosterone therapy
because of a rise in serum PSA above 4.0 ng/mL. One patient (1.9%) was diagnosed
with prostate cancer. In conclusion, testosterone replacement therapy in men
with erectile dysfunction and hypogonadism is associated with a minor PSA elevation,
but there does not appear to be a short-term increase in risk for the development
of prostate cancer.
PMID: 12399540, UI: 22286515
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