Flores Jose M, Vertosick Emily A, Salter Carolyn A, Liso Nicole, Teloken Patrick, Berookhim Boback, Jenkins Lawrence, Carlsson Sigrid, Laudone Vincent, Eastham James, Vickers Andrew J, Mulhall John P
Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
J Urol. 2025 Jan;213(1):27-33. doi: 10.1097/JU.0000000000004267. Epub 2024 Sep 30.
Testosterone (T) therapy (TTh) in men with T deficiency who have undergone radical prostatectomy (RP) for prostate cancer remains controversial. We aimed to assess the impact of TTh on biochemical recurrence (BCR) rates after RP in men with low-intermediate organ-confined disease.
This study included men who underwent an RP at our institution for organ-confined prostate cancer and had grade groups 1 to 3 on RP pathology. A Cox model was created for time to BCR with T use included as a time-dependent covariate, adjusted for age, preoperative PSA, grade group at RP, and the presence of comorbidities. A landmark analysis was used: Patients were included in the analysis if their last PSA in the 18 weeks postoperatively was undetectable and they had not had BCR or been lost to follow-up by that point, and follow-up for BCR began at 18 weeks. BCR was defined as a PSA ≥ 0.1 ng/mL after RP with a second confirmatory rise ≥ 0.1 ng/mL.
The study population included 5199 men after RP, with 198 patients receiving T at any point after RP and 5001 not receiving T. The median age was 59 (interquartile range, 55-65) and 61 (interquartile range, 56-66) years, respectively. Men in the T group tended to present with more vascular comorbidities. For those receiving T, clomiphene citrate was prescribed in 49% of men, 32% received transdermal T, and 19% intramuscular T. We found a nonsignificantly decreased risk of BCR associated with the use of T after RP (hazard ratio, 0.84; 95% CI, 0.48-1.46; = .5), and overall rates of BCR were low, with probability of BCR at 5 years less than 2% in both groups.
TTh can be given to select men after RP. We found no evidence that administration of TTh after RP causes BCR.
对于因前列腺癌接受根治性前列腺切除术（RP）的睾酮（T）缺乏男性患者，T治疗（TTh）仍存在争议。我们旨在评估TTh对低中级器官局限性疾病男性患者RP后生化复发（BCR）率的影响。
本研究纳入了在我们机构因器官局限性前列腺癌接受RP且RP病理分级为1至3级的男性患者。建立了一个Cox模型，以BCR时间为观察指标，将T的使用作为时间依赖性协变量，并对年龄、术前前列腺特异性抗原（PSA）、RP时的分级组以及合并症的存在情况进行调整。采用了一项标志性分析：如果患者术后18周的最后一次PSA检测不到，且此时未发生BCR或失访，则将其纳入分析，BCR随访从18周开始。BCR定义为RP后PSA≥0.1 ng/mL且第二次确认升高≥0.1 ng/mL。
研究人群包括5199例RP后的男性患者，其中198例患者在RP后的任何时间接受了T治疗，5001例未接受T治疗。中位年龄分别为59岁（四分位间距，55 - 65岁）和61岁（四分位间距，56 - 66岁）。T组男性患者往往合并更多血管方面的疾病。在接受T治疗的患者中，49%的男性使用了枸橼酸氯米芬，32%接受经皮T治疗，19%接受肌肉注射T治疗。我们发现RP后使用T与BCR风险降低无显著相关性（风险比，0.84；95%置信区间，0.48 - 1.46；P = 0.5），且总体BCR率较低，两组5年时BCR的概率均小于2%。
RP后的特定男性患者可以接受TTh治疗。我们没有发现证据表明RP后给予TTh会导致BCR。
