Urology department, Sorbonne University, GRC n 5, PREDICTIVE ONCO-UROLOGY, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France.
Service d'urologie, Clinique Pasteur, Royan, France; GRC n 5 PREDICTIVE ONCO-UROLOGY, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France.
Urol Oncol. 2020 Aug;38(8):661-670. doi: 10.1016/j.urolonc.2020.04.008. Epub 2020 May 11.
Often contraindicated because of the theoretical risk of progression based on the dogma of hormone dependent prostate cancer (CaP), testosterone replacement therapy (TRT) is increasingly discussed and proposed for hypogonadal patients with localized CaP. To perform a systematic literature review to determine the relationship between TRT and the risk of CaP with a focus on the impact of TRT in the setting of previous or active localized CaP. As of October 15, 2019, systematic review was performed via Medline Embase and Cochrane databases in accordance with the PRISMA guidelines. All full text articles in English published from January 1994 to February 2018 were included. Articles were considered if they reported about the relationship between total testosterone or bioavailable testosterone and CaP. Emphasis was given to prospective studies, series with observational data and randomized controlled trials. Articles about the safety of the testosterone therapy were categorized by type of CaP management (active surveillance or curative treatment by radical prostatectomy, external radiotherapy or brachytherapy). Until more definitive data becomes available, clinicians wishing to treat their hypogonadal patients with localized CaP with TRT should inform them of the lack of evidence regarding the safety of long-term treatment for the risk of CaP progression. However, in patients without known CaP, the evidence seems sufficient to think that androgen therapy does not increase the risk of subsequent discovery of CaP.
由于基于激素依赖性前列腺癌（CaP）的教条理论上存在进展的风险，因此通常不建议使用睾酮替代疗法（TRT），但对于患有局限性 CaP 的低睾酮患者，TRT 越来越多地被讨论和提出。为了进行系统的文献回顾，以确定 TRT 与 CaP 风险之间的关系，重点关注 TRT 在先前或活动性局限性 CaP 背景下的影响。截至 2019 年 10 月 15 日，根据 PRISMA 指南，通过 Medline、Embase 和 Cochrane 数据库进行了系统评价。纳入了自 1994 年 1 月至 2018 年 2 月发表的所有英文全文文章。如果报告了总睾酮或生物可利用睾酮与 CaP 之间的关系，则认为这些文章是相关的。重点是前瞻性研究、具有观察性数据的系列研究和随机对照试验。关于睾酮治疗安全性的文章根据 CaP 管理类型（主动监测或根治性前列腺切除术、外放射治疗或近距离放射治疗）进行分类。在更明确的数据出现之前，希望用 TRT 治疗局限性 CaP 低睾酮患者的临床医生应该告知他们，关于长期治疗 CaP 进展风险的安全性缺乏证据。然而，对于没有已知 CaP 的患者，证据似乎足以认为雄激素治疗不会增加随后发现 CaP 的风险。
