Natale Caleb, Carlos Carmen, Hong Jennifer, Khera Mohit, Baum Neil, Raheem Omer A
Department of Urology, Tulane University, New Orleans, LA, USA.
Department of Urology, Baylor College of Medicine, Houston, TX, USA.
Sex Med Rev. 2021 Jul;9(3):393-405. doi: 10.1016/j.sxmr.2020.12.003. Epub 2021 Jan 28.
Although testosterone therapy (TTh) is the standard practice in otherwise healthy hypogonadal men, this therapy has historically been contraindicated in men with a history of prostate cancer. Recent evidence suggests that there is minimal or no prostate cancer growth in the setting of TTh administration in men definitively treated for non-metastatic prostate cancer.
To review the evidence supporting the safety and efficacy of TTh in patients previously treated for localized prostate cancer.
A literature review of the PubMed database was performed to identify studies evaluating the safety and efficacy of TTh in patients with a history of prostate cancer. Search terms included Testosterone Therapy, Testosterone Replacement Therapy and Radical Prostatectomy, Radiotherapy, External Beam Radiation Therapy, EBRT, Brachytherapy; Prostate Cancer and Hypogonadism, Low Testosterone; Bipolar Androgen Therapy.
Available literature provides evidence for the safe application of TTh in patients previously treated for prostate cancer with either radical prostatectomy or radiotherapy. Furthermore, there exists evidence that severely hypogonadal levels of testosterone may lead to worse oncological outcomes. More recent research has begun to elucidate the effectiveness of bipolar androgen deprivation therapy in the treatment of prostate cancer. This mechanism of action increases the level of evidence indicating that the traditional management of maintaining testosterone levels at low levels may no longer be standard of care. TTh likely has a role in improved erectile function and other quality-of-life concerns in patients developing testosterone deficiency after being treated for prostate cancer.
TTh should be offered to select hypogonadal patients who have a history of definitively treated prostate cancer. Adequately designed randomized controlled trials are necessary to confirm the safety and efficacy of TTh in this population. Natale C, Carlos C, Hong J, et al. Testosterone Replacement Therapy After Prostate Cancer Treatment: A Review of Literature. Sex Med Rev 2021;9:393-405.
尽管睾酮治疗（TTh）是健康性腺功能减退男性的标准治疗方法，但该疗法在有前列腺癌病史的男性中历来被视为禁忌。最近的证据表明，在已接受非转移性前列腺癌明确治疗的男性中，进行TTh治疗时前列腺癌生长极少或没有生长。
回顾支持TTh对既往接受局限性前列腺癌治疗患者的安全性和有效性的证据。
对PubMed数据库进行文献综述，以识别评估TTh对有前列腺癌病史患者的安全性和有效性的研究。检索词包括睾酮治疗、睾酮替代治疗以及根治性前列腺切除术、放射治疗、外照射放疗、近距离放射治疗；前列腺癌与性腺功能减退、低睾酮；双相雄激素治疗。
现有文献为TTh在既往接受前列腺癌根治术或放疗患者中的安全应用提供了证据。此外，有证据表明，严重性腺功能减退的睾酮水平可能导致更差的肿瘤学结局。最新研究已开始阐明双相雄激素剥夺疗法在前列腺癌治疗中的有效性。这种作用机制提高了证据水平，表明将睾酮水平维持在低水平的传统治疗方法可能不再是标准治疗。TTh可能在改善前列腺癌治疗后出现睾酮缺乏患者的勃起功能及其他生活质量问题方面发挥作用。
对于选定的有明确前列腺癌治疗史的性腺功能减退患者，应提供TTh治疗。需要进行充分设计的随机对照试验对于证实TTh在该人群中的安全性和有效性是必要的。纳塔莱C、卡洛斯C、洪J等。前列腺癌治疗后的睾酮替代治疗：文献综述。性医学评论2021；9：393 - 405。
