No increase in prostate cancer risk with testosterone replacement
medwireNews: Testosterone replacement therapy (TRT) is not associated with an increase in total prostate cancer risk, and may even decrease the risk for aggressive disease.
The analysis, reported in the Journal of Clinical Oncology and based on the National Prostate Cancer Register of Sweden and linked healthcare databases, comprised 38,570 men with prostate cancer and 192,838 age-matched controls. Of these, 284 (1%) and 1378 (1%), respectively, had filled prescriptions for TRT.
After adjusting for confounders, receipt of TRT was not significantly associated with overall prostate cancer risk (odds ratio [OR]=1.03), but the risk for aggressive disease (including high-risk, locally advanced, regional, and distant metastatic prostate cancer) was significantly lower among men who did versus did not receive TRT (OR=0.50).
Researcher Stacy Loeb, from New York University in the USA, and co-workers say that the link is biologically plausible – for instance, TRT is used to treat hypogonadism, which has been associated with a higher risk for aggressive prostate cancer. But they add that further investigation is warranted.
The study authors also found that favorable-risk prostate cancer (low- and intermediate-risk) was significantly more common among men in the TRT group (OR=1.35). However, they attribute this result to detection bias, especially as the increase was observed during the first year of treatment, whereas the association with aggressive disease did not become evident until after at least a year of TRT.
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