Presentation Authors: Reith Sarkar, J Kellogg Parsons*, John Einck, Arno Mundt, A Karim Kader, Christopher Kane, Paul Riviere, Rana McKay, James Murphy, Brent Rose, La Jolla, CA
Introduction: The safety of testosterone replacement therapy in men who have undergone radical prostatectomy (RP) for localized prostate cancer remains undefined.
Methods: In a large national cohort, the Veterans Affairs Informatics and Computing Infrastructure, we identified node-negative and non-metastatic prostate cancer patients diagnosed between 2001-2015 treated with RP. We excluded patients for missing covariate and follow-up data. We then coded receipt of testosterone replacement after RP as a time-dependent covariate. Other covariates included: age, Charlson Comorbidity index, diagnosis year, body mass index, race, PSA, clinical T/N/M stage, Gleason score, and receipt of hormone therapy. Biochemical recurrence was defined as a post-RP PSAâ‰¥0.2. We evaluated prostate cancer-specific survival, overall survival, and biochemical recurrence free survival using multivariable Cox regression.
Results: Our cohort included 28,651 patients, of whom 469 (1.6%) received testosterone replacement after RP. Median follow up was 7.4 years. There were no differences in clinical T stage, median post-RP PSA (testosterone: 0 non-testosterone: 0; p=0.18), or hormone therapy use between treatment groups. Testosterone patients were more likely to be of younger age, have higher comorbidity, non-black, have a lower median pre-treatment PSA (5.0 vs 5.8; p < 0.001), and have higher BMI. The median time from RT to TRT was 3.0 years. After controlling for potential confounders, we found no difference in prostate cancer specific mortality (HR 0.73; 95% CI 0.32-1.62; p=0.43), overall survival (HR 1.11; 95% CI 0.86-1.44; p=0.43), non-cancer mortality (HR 1.17; 95% CI 0.89-1.55; p=0.26) biochemical recurrence free survival (HR 1.07; 95% CI 0.84-1.36; p=0.59) between testosterone users and non-users.
Conclusions: To our knowledge, this cohort is the largest comparative analysis to date of testosterone therapy after RP. These data suggest that testosterone replacement is safe in patients who have undergone definitive management of localized prostate cancer with RP.