Shoskes Daniel A, Barazani Yagil, Fareed Khaled, Sabanegh Edmund
Department of Urology, Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA.
Int Braz J Urol. 2015 Nov-Dec;41(6):1167-71. doi: 10.1590/S1677-5538.IBJU.2014.0528.
The relationship between Testosterone Replacement Therapy (TRT) and prostate cancer remains controversial. Most TRT studies show no change in prostate specific antigen (PSA) but some men do have PSA rise or develop an abnormal digital rectal exam (aDRE). Our objective was to examine the biopsy results of men with symptomatic hypogonadism before or during therapy.
Data was extracted from our medical record on men with hypogonadism who had a prostate biopsy within the past 4 years done by 3 Urologists with guideline driven practice patterns.
96 men were identified. Mean age at biopsy was 63 (range 40-85) and median PSA was 3.78ng/dL (0.5-662). Of the 61 men not on TRT, median PSA was 4.34 (0.5 to 662) and mean total testosterone 254 (191-341). There were 29 (47.5%) prostate cancers found (6 Gleason score 6, 13 Gleason score 7, 10 Gleason score 8 or 9). Of the 35 men on TRT, median PSA was 3.27 (0.5 to 13.7). The %PSA increase ranged from 2 to 251% (mean 93.5%). Mean total testosterone was 383 (146-792). Of the 14 men treated < 2 years, none had cancer. Of the 21 men treated 2 or more years 5 had cancer (2 Gleason score 6, 3 Gleason score 7).
Men with hypogonadism and a clinical indication for biopsy often have prostate cancer, many high grade. No men with an initial PSA rise on TRT had cancer. Men on long term TRT should be monitored with PSA and DRE per guidelines.
睾酮替代疗法（TRT）与前列腺癌之间的关系仍存在争议。大多数TRT研究显示前列腺特异性抗原（PSA）无变化，但有些男性确实出现PSA升高或直肠指检异常（aDRE）。我们的目的是检查有症状性腺功能减退男性在治疗前或治疗期间的活检结果。
从我们的病历中提取过去4年内由3名遵循指南的泌尿外科医生对性腺功能减退男性进行前列腺活检的数据。
共确定96名男性。活检时的平均年龄为63岁（范围40 - 85岁），PSA中位数为3.78ng/dL（0.5 - 662）。在61名未接受TRT的男性中，PSA中位数为4.34（0.5至662），总睾酮平均为254（191 - 341）。发现29例（47.5%）前列腺癌（6例Gleason评分为6分，13例Gleason评分为7分，10例Gleason评分为8或9分）。在35名接受TRT的男性中，PSA中位数为3.27（0.5至13.7）。PSA升高百分比范围为2%至251%（平均93.5%）。总睾酮平均为383（146 - 792）。在治疗<2年的14名男性中，无人患癌。在治疗2年或更长时间的21名男性中，5人患癌（2例Gleason评分为6分，3例Gleason评分为7分）。
有性腺功能减退且有临床活检指征的男性常患有前列腺癌，许多为高级别。TRT初始PSA升高的男性无人患癌。长期接受TRT的男性应按照指南进行PSA和DRE监测。
