TY - JOUR
T1 - To treat or not to treat with testosterone replacement therapy
T2 - A contemporary review of management of late-onset hypogonadism and critical issues related to prostate cancer
AU - Kava, Bruce R.
PY - 2014/7
Y1 - 2014/7
N2 - Over the last 10 years there has been a dramatic increase in the number of patients identified and treated with testosterone replacement therapy (TRT) for late-onset hypogonadism (LOH). By virtue of age, race, and family history, many of these patients are concurrently at risk for harboring indolent prostate cancer. Other men are at increased risk for prostate cancer as a result of an elevated serum PSA level or having had a prior prostate biopsy showing prostatic intraepithelial neoplasia (PIN) or atypical small acinar proliferation (ASAP). The clinician is often challenged with the decision whether to initiate TRT in these patients. This review presents a contemporary overview of the rationale for TRT, as well as the relationship between testosterone (endogenous and exogenous) and premalignant and malignant lesions of the prostate. We will discuss preliminary data from several recent series demonstrating that TRT may be safely administered in select patients with certain premalignant and bona fide malignant tumors of the prostate. In the absence of a large randomized clinical trial with long-term outcome data evaluating TRT, we hope that this overview will provide clinicians with an evidence-based approach to managing these anxiety-provoking - and often frustrating - clinical scenarios.
AB - Over the last 10 years there has been a dramatic increase in the number of patients identified and treated with testosterone replacement therapy (TRT) for late-onset hypogonadism (LOH). By virtue of age, race, and family history, many of these patients are concurrently at risk for harboring indolent prostate cancer. Other men are at increased risk for prostate cancer as a result of an elevated serum PSA level or having had a prior prostate biopsy showing prostatic intraepithelial neoplasia (PIN) or atypical small acinar proliferation (ASAP). The clinician is often challenged with the decision whether to initiate TRT in these patients. This review presents a contemporary overview of the rationale for TRT, as well as the relationship between testosterone (endogenous and exogenous) and premalignant and malignant lesions of the prostate. We will discuss preliminary data from several recent series demonstrating that TRT may be safely administered in select patients with certain premalignant and bona fide malignant tumors of the prostate. In the absence of a large randomized clinical trial with long-term outcome data evaluating TRT, we hope that this overview will provide clinicians with an evidence-based approach to managing these anxiety-provoking - and often frustrating - clinical scenarios.
KW - Atypical small acinar proliferation
KW - Late-onset hypogonadism
KW - Prostate cancer
KW - Prostatic intraepithelial neoplasia
KW - Testosterone replacement therapy
UR - http://www.scopus.com/inward/record.url?scp=84901527716&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84901527716&partnerID=8YFLogxK
U2 - 10.1007/s11934-014-0422-5
DO - 10.1007/s11934-014-0422-5
M3 - Review article
C2 - 24832199
AN - SCOPUS:84901527716
VL - 15
JO - Current Urology Reports
JF - Current Urology Reports
SN - 1527-2737
IS - 7
M1 - 422
ER -