University of Washington, Seattle, Washington, United States of America.
VA Puget Sound Health Care System, Seattle, Washington, United States of America.
PLoS One. 2018 Jun 22;13(6):e0199194. doi: 10.1371/journal.pone.0199194. eCollection 2018.
Testosterone treatment of men with low testosterone is common and, although relatively short-term, has raised concern regarding an increased risk of prostate cancer (CaP). We investigated the association between modest-duration testosterone treatment and incident aggressive CaP.
Retrospective inception cohort study of male Veterans aged 40 to 89 years with a laboratory-defined low testosterone measurement from 2002 to 2011 and recent prostate specific antigen (PSA) testing; excluding those with recent testosterone treatment, prostate or breast cancer, high PSA or prior prostate biopsy. Histologically-confirmed incident aggressive prostate cancer or any prostate cancer were the primary and secondary outcomes, respectively.
Of the 147,593 men included, 58,617 were treated with testosterone. 313 aggressive CaPs were diagnosed, 190 among untreated men (incidence rate (IR) 0.57 per 1000 person years, 95% CI 0.49-0.65) and 123 among treated men (IR 0.58 per 1000 person years; 95% CI 0.48-0.69). After adjusting for age, race, hospitalization during year prior to cohort entry, geography, BMI, medical comorbidities, repeated testosterone and PSA testing, testosterone treatment was not associated with incident aggressive CaP (HR 0.89; 95% CI 0.70-1.13) or any CaP (HR 0.90; 95% CI 0.81-1.01). No association between cumulative testosterone dose or formulation and CaP was observed.
Among men with low testosterone levels and normal PSA, testosterone treatment was not associated with an increased risk of aggressive or any CaP. The clinical risks and benefits of testosterone treatment can only be fully addressed by large, longer-term randomized controlled trials.
男性低睾酮症的睾酮治疗很常见，虽然治疗时间相对较短，但人们对其是否会增加前列腺癌（CaP）的风险表示担忧。我们研究了适度时间的睾酮治疗与侵袭性 CaP 发病之间的关系。
这是一项回顾性队列研究，纳入了年龄在 40 至 89 岁之间的男性退伍军人，他们在 2002 年至 2011 年间进行了实验室定义的低睾酮检测，并进行了最近的前列腺特异性抗原（PSA）检测；排除了最近接受过睾酮治疗、前列腺癌或乳腺癌、高 PSA 或前列腺活检史的患者。组织学确诊的侵袭性前列腺癌或任何前列腺癌分别为主要和次要结局。
在纳入的 147593 名男性中，58617 名接受了睾酮治疗。诊断出 313 例侵袭性 CaP，未治疗男性中发病率为 0.57/1000 人年（95%CI 0.49-0.65），治疗男性中发病率为 0.58/1000 人年（95%CI 0.48-0.69）。在调整年龄、种族、队列入组前一年住院情况、地理位置、BMI、合并症、重复睾酮和 PSA 检测后，睾酮治疗与侵袭性 CaP（HR 0.89；95%CI 0.70-1.13）或任何 CaP（HR 0.90；95%CI 0.81-1.01）的发病无关。未观察到累积睾酮剂量或制剂与 CaP 之间的关联。
在低睾酮水平和正常 PSA 的男性中，睾酮治疗与侵袭性或任何 CaP 的风险增加无关。只有通过大规模、长期的随机对照试验，才能充分了解睾酮治疗的临床风险和获益。
