Testosterone replacement therapy reduces biochemical recurrence post‐radical prostatectomy

BACKGROUND: To evaluate risk of prostate cancer biochemical recurrence following radical prostatectomy in men receiving versus not receiving testosterone therapy. PATIENTS AND METHODS: 850 patients underwent radical prostatectomy by a single surgeon. All patients had preoperative testosterone and sex hormone binding globulin levels drawn; free testosterone was calculated prospectively.152 (18%) patients with low preoperative calculated free testosterone levels and delayed post-operative sexual function recovery were placed on testosterone therapy and proportionately matched to 419 control patients by pathologic Gleason Grade Group and stage. Rates and time to biochemical recurrence (two consecutive prostate specific antigen >/= 0.2 ng/dl) were compared in univariate and multivariate regression; Cox regression was used to generate a survival function at the mean of covariates. RESULTS: Median follow-up was 3.5 years. There were no statistically significant differences in demographics or general health complications between groups. 11/152 (7.2%) and 53/419 (12.6%) patients experienced biochemical recurrence in the testosterone therapy versus control groups, respectively. In adjusted time to event analysis, testosterone therapy was an independent predictor of recurrence-free survival. After accounting for Gleason Grade Group, pathologic stage, preoperative prostate specific antigen, and calculated free testosterone, patients on testosterone therapy were approximately 54% less likely to recur (HR:0.54, 95%CI:0.292-0.997). In men destined to recur, testosterone therapy delayed time to recurrence by an average of 1.5 years. CONCLUSION: In our experience, testosterone replacement post-radical prostatectomy significantly reduced recurrence and delayed time to recurrence. There were no identifiable general health complications associated with testosterone therapy. These findings are hypothesis-generating and require confirmation with multi-centered, prospective randomized controlled trials.