Testosterone and Prostate Safety

Abstract

Objective: To review the safety of testosterone (T) therapy with regard to the prostate, with special emphasis on the controversial association between testosterone and prostate cancer.

Methods: We reviewed the existing scientific and medical literature pertaining to the impact of T treatment on the prostate.

Results: No large-scale, long-term controlled studies of T therapy versus placebo have yet been performed to document prostate safety. However, there is a wealth of evidence from smaller clinical trials as well as population-based longitudinal studies that fails to demonstrate any signal suggesting that T therapy in hypogonadal adult men poses an increased risk of prostate cancer. New evidence indicates that exogenous T does not raise intraprostatic T or dihydrotestosterone concentrations. Indeed, there is accumulating evidence that low serum T is associated with increased risk of prostate cancer and that these cancers may have more worrisome aggressive clinical features. In addition, multiple studies have failed to show that T therapy causes worsening of voiding symptoms due to benign prostatic hyperplasia.

Conclusions: Despite the long-held belief that T therapy may pose an increased risk of prostate cancer, the available evidence strongly suggests that T therapy is safe for the prostate. Given that the population at risk for hypogonadism overlaps with the population at risk for prostate cancer, it is strongly recommended that men undergoing T therapy undergo regular monitoring for prostate cancer.

The great enemy of the truth is very often not the lie…. but the myth, persistent, persuasive and unrealistic John F. Kennedy