TESTOSTERONE THERAPY IN MEN ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER IS NOT ASSOCIATED WITH INCREASED RISK OF DISEASE PROGRESSION.

Abstract

Testosterone therapy (TTH) in men with prostate cancer (PC) remains controversial, with limited data on cancer specific outcomes for patients on TTH available, particularly for those on Active Surveillance (AS). This study aimed to assess the safety of TTh in men on AS for PC. The records of patients with Grade Group (GG) 1 and 2 PC on AS were reviewed, including a subset who were concurrently treated with TTH. Institutional protocols for AS consisted of lab work and exam every 6 months, MRI every 18 months, and biopsy every 36 months. Men on TTH had total testosterone and PSA labs drawn within 2-4 weeks of TTH initiation and every 6 months when stable on dosing. The primary outcome was time to progression, defined as a rise in GG on biopsy. A secondary outcome used an alternative definition of progression to definitive treatment. The study included 3,324 AS patients, with 79 on TTH. 1,256 (38%) patients had progression on biopsy. On multivariable analysis, TTH did not significantly impact the risk of disease progression (HR 0.99; 95% CI: 0.67,1.48; p>0.9), with adjusted survival curves failing to demonstrate clinically meaningful differences in event rates. Similarly, TTH did not impact progression to definitive treatment (HR 0.94; 95% CI: 0.64, 1.38; p=0.8). While TTh can be used in patients on active surveillance, careful monitoring is indicated and further research necessary to confirm oncologic safety with larger and more mature cohorts.