Dr. Agrawal is associate professor; Dr. Bresler is an assistant professor, Department of Surgery, Division of Urology; and Dr. Silva is an assistant professor of Public Health Sciences; all at the Loyola Stritch School of Medicine in Maywood, Illinois. At the time the article was written, Dr. Arceo-Mendoza, Dr. Barnosky, Dr. Chiha, and Dr. Wilczynski were fellows at Edward Hines, Jr, VA Hospital (EHJVAH) in Hines, Illinois. Dr. Silva is a Research Health Scientist at the Center of Innovation for Complex Chronic Healthcare at EHJVAH. Dr. Agrawal is an endocrinologist and Dr. Bresler is a urology physician, both at EHJVAH.
References
Conclusion
As life expectancy increases, many survivors of treated PCa present with symptoms of hypogonadism associated with low serum T levels and request TRT. The prevalence of hypogonadism before or after treatment for PCa in this population is not known. This study suggests that many low-risk PCa survivors have hypogonadism. Because hypogonadism negatively impacts quality of life by increasing the risk for sexual dysfunction, mood disturbances, bone fracture, development of metabolic syndrome, frailty, and decline in the feeling of general well-being and may have significant deleterious effects on other body systems, consideration for treatment is warranted.
Patients with PCa may be untreated because the safety of TRT in this population is unknown. Clinical practice guidelines caution against using TRT in this population, and recent literature questions the benefits and risks associated with the long-term safety of TRT, particularly in older men. 28,41 Although further studies are necessary before definitive conclusions can be drawn, increasing evidence, albeit small, suggests that TRT can be cautiously considered in selected hypogonadal men treated with curative intent for PCa and without evidence of active disease. However, because obese patients are at higher risk for aggressive PCa and mortality, it is unclear whether obese PCa survivors have an additional risk in regard to TRT. 42,43 To help clinicians provide information and care for their patients, appropriately designed prospective randomized studies using a collaborative approach and long-term follow-up are urgently needed to determine the safety of TRT in hypogonadal men with a history of low-risk PCa.
Acknowledgments This material is the result of work supported with resources and the use of facilities at the Edward Hines Jr. VA Hospital. Dr. Silva’s work was carried out while she was a postdoctoral fellow supported by the VA Office of Academic Affiliations (TPP 42-013). The authors thank Ahmer V. Farooq, DO, Department of Surgery, Division of Urology, for his help in planning the design of the study. Dr. Agrawal affirms that all coauthors contributed significantly to the work and had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
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