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Radical Prostatectomy and Testosterone Therapy: What Patients Should Know

Understanding the Risks and Benefits of Testosterone Therapy Post-Prostate Surgery

In recent years, testosterone therapy has become a topic of interest and debate in the medical community, especially when considering its use after radical prostatectomy for prostate cancer.

This article delves into the intricacies of testosterone therapy, its purpose, and the controversial aspects surrounding its application post-prostatectomy.

We will explore various studies, expert opinions, and the cautious approach adopted by Physicians Rejuvenation Centers in navigating this complex treatment landscape.

We aim to provide a comprehensive understanding of the risks, benefits, and ongoing research in this area, guiding patients and healthcare providers in making informed decisions.

What Is Testosterone Therapy and Its Purpose?

Testosterone therapy, also known as testosterone replacement therapy (TRT), involves administering testosterone to treat low levels of the hormone, a condition known as hypogonadism or low testosterone.

The therapy aims to restore normal testosterone levels and alleviate symptoms associated with low testosterone such as low libido, erectile dysfunction, decreased energy, and loss of muscle mass.

Testosterone therapy comes in different forms including injections, gels, patches and pellets implanted under the skin. It has been used for decades to effectively treat hypogonadism and improve quality of life in men with low testosterone.

However, its use specifically after radical prostatectomy surgery for prostate cancer remains controversial.

Understanding Radical Prostatectomy: What Is It and Why Is It Done?

Radical prostatectomy is the surgical removal of the entire prostate gland plus some surrounding tissue. It is most often done to treat prostate cancer before it spreads beyond the prostate.

During a radical prostatectomy, the surgeon removes the prostate and seminal vesicles. They may also remove nearby lymph nodes to check for cancer spread.

There are different approaches to radical prostatectomy:

  • Open surgery with a large incision in the lower abdomen
  • Laparoscopic where small incisions allow the use of tiny cameras and instruments
  • Robotic-assisted laparoscopic surgery controlled by a surgeon at a console

Radical prostatectomy has risks, including urinary incontinence and erectile dysfunction. But it can cure prostate cancer in men with localized disease.

Why Is Testosterone Therapy After Radical Prostatectomy Controversial?

Using testosterone therapy after prostate cancer treatment is controversial for a few key reasons:

  • No large randomized controlled trials: There is an absence of large, long-term randomized placebo-controlled trials looking specifically at testosterone therapy after radical prostatectomy. This type of robust data is needed to definitively prove safety.
  • Fear of stimulating cancer recurrence: There are long-standing fears that raising testosterone levels after prostate cancer treatment could stimulate recurrent cancer growth. This belief originated from early research linking prostate cancer progression to testosterone.
  • Conflicting study results: While some studies have shown testosterone therapy did not increase PSA levels or cancer recurrence, others have questioned the safety. Overall the data is conflicting and inconclusive.
  • Ongoing medical debate: Due to limited data, there is still debate within the medical community about whether the potential benefits of testosterone therapy outweigh the unknown recurrence risks after radical prostatectomy.

What Have Studies Found About Testosterone Therapy Post-Prostatectomy?

Several studies have explored the impact of testosterone therapy after radical prostatectomy with varying results:

  • The 2009 study reviewed 57 hypogonadal men, aged 53 to 83, who received testosterone replacement therapy (TRT) following radical prostatectomy. Over an average of 36 months post-surgery and 13 months of TRT, testosterone levels significantly increased from 255 ng/dL to 459 ng/dL without any rise in PSA levels, indicating no cancer recurrence. This suggests that TRT is safe and effective in improving testosterone levels in these patients without promoting tumor progression.
  • A 2020 study observed 152 men who received testosterone therapy after prostatectomy had a 54% lower risk of PSA recurrence compared to controls over 3.5 years. Time to recurrence was delayed by 1.5 years on average.
  • In a study of 28,651 prostate cancer patients treated with radical prostatectomy, 469 (1.6%) received testosterone replacement therapy (TRT). With a median follow-up of 7.4 years, the study found no significant differences in prostate cancer-specific mortality, overall survival, non-cancer mortality, or biochemical recurrence between TRT users and non-users after adjusting for variables like age, comorbidities, and PSA levels. This suggests that TRT is safe for prostate cancer patients post-surgery, although further prospective data is needed for confirmation.
  • Another study in 2021 did a “testosterone challenge” on 22 men after prostatectomy. 5 men had an increased PSA level following testosterone administration.

Overall, studies suggest testosterone therapy may be safe in selected patients after radical prostatectomy. However, concerns remain over temporary PSA increases and the lack of large, long-term randomized trials.

Navigating the Risks: What Should Patients Know?

For patients considering testosterone therapy after prostate cancer treatment, it’s essential to understand the potential risks:

  • Cancer recurrence: The biggest concern is the testosterone-fueled growth of the remaining prostate cancer cells missed after surgery, increasing PSA levels and recurrence risk.
  • Rapid growth if recurrence: Some research suggests testosterone may accelerate cancer growth in the event of recurrence. This could lead to earlier metastasis.
  • No long-term safety data: Without randomized controlled trials, the long-term safety of testosterone therapy for 5-10 years after prostatectomy remains unknown.

Discussing these potential risks and weighing them against possible symptom relief for low testosterone is imperative. Monitoring PSA levels and being vigilant for signs of recurrence is crucial.

How Are Eligibility and Safety Determined for Patients Considering This Therapy?

The candidates for testosterone therapy after radical prostatectomy must meet strict criteria:

  • Organ-confined prostate cancer with negative surgical margins
  • Undetectable PSA levels with no signs of recurrence
  • Severely low testosterone levels with hypogonadal symptoms poorly responsive to other measures
  • At least 1 year after prostatectomy to allow PSA stabilization
  • Fully informed of risks and consenting to close monitoring

Medical professionals should monitor patients every 3 months with PSA testing, testosterone level assessment, and digital rectal exams. Testosterone is administered via gels or injections in the lowest effective doses. Any concerning test results or side effects prompt discontinuation of therapy.

What Alternatives Exist for Managing Symptoms of Low Testosterone Post-Surgery?

Some options for patients struggling with low testosterone symptoms after prostate cancer surgery include:

  • Lifestyle changes like improved diet, exercise, sleep habits
  • Trying herbal supplements like Tongkat Ali or Ashwagandha
  • Non-hormonal medications for erectile dysfunction like Viagra or Cialis
  • Psychotherapy and counseling for issues like depression or relationship problems
  • Cognitive behavioral therapy and relaxation techniques for low energy or quality of life

While not as effective as testosterone therapy, these alternatives may help certain patients avoid the risks of raising testosterone after prostate cancer treatment.

What Does the Future Hold for Testosterone Therapy After Radical Prostatectomy?

Right now, the use of testosterone therapy after radical prostatectomy remains controversial and off-label. But in the future, we may see:

  • Larger, multi-center randomized controlled trials to truly assess long-term safety and efficacy
  • Updated treatment guidelines if new research affirms safety in selected patients
  • Newer formulations of testosterone with reduced prostate cancer risk
  • Greater understanding of the saturation model and threshold for exogenous testosterone’s impact on prostate cancer growth
  • Increased access and comfort prescribing testosterone therapy off-label for appropriate candidates

With time, the risks and benefits will hopefully become clearer, allowing for more informed decisions. But for now, careful consideration of testosterone therapy after prostate cancer surgery remains warranted.

How Can Patients Make an Informed Decision on Testosterone Therapy Post-Prostatectomy?

For patients considering testosterone therapy after radical prostatectomy, we suggest:

  • Having an in-depth discussion with your urologist and/or endocrinologist about potential benefits and risks
  • Ensuring your testosterone levels have been properly evaluated more than once
  • Understanding your prostate cancer prognosis and risk of recurrence without testosterone therapy
  • Reviewing the limited safety data and conflicting study results
  • Recognizing the lack of FDA approval and long-term data for this use
  • Accepting the unknowns and need for very close monitoring if pursuing therapy
  • Considering safer lifestyle modifications and alternatives to boost low testosterone symptoms first
  • Proceeding slowly and cautiously if choosing testosterone therapy

While some men may benefit from carefully managed testosterone therapy after radical prostatectomy, it is not yet ready for widespread, routine use. Have an honest conversation with your doctor to determine if it aligns with your specific health status and priorities.

Final Thoughts

While testosterone therapy post-radical prostatectomy shows promise in improving testosterone levels without significantly increasing PSA levels or cancer recurrence risks, it remains a controversial and off-label treatment.

The absence of long-term randomized controlled trials and varying study results necessitate a cautious approach.

Patients must carefully weigh the potential benefits against the risks, engage in thorough discussions with healthcare providers, and consider alternative treatments.

As research progresses, more definitive guidelines and safer therapy options may emerge, offering clearer pathways for men recovering from prostate cancer surgery.

How Do Physicians Rejuvenation Centers View Testosterone Therapy After Prostate Surgery?

At Physicians Rejuvenation Centers, we take a cautious yet balanced approach to testosterone therapy after radical prostatectomy for prostate cancer.

While limited, we recognize that current evidence indicates the treatment may be safe for some selected patients under close supervision and monitoring. We also understand the potential benefits of relieving persistent symptoms of low testosterone.

However, we are adamant about closely tracking PSA levels and cancer recurrence risks when administering testosterone therapy to any prostatectomy patients. Patient safety is always our top priority.

We have strict protocols in place to carefully screen patients for eligibility and closely monitor their health on an ongoing basis if testosterone therapy is initiated. Patients must meet specific criteria, including:

  • Organ-confined prostate cancer with negative surgical margins
  • Undetectable PSA after prostatectomy
  • Symptoms of low testosterone persistently impacting quality of life

We frequently re-evaluate the therapy and will discontinue treatment for any concerning test results or indications of cancer recurrence.

Interested in testosterone therapy after prostate surgery? Get in touch with our experts for a thorough evaluation and personalized care.