Testosterone Therapy Doesn't Seem to Raise Cancer Risk in Men

By Will Boggs MD

October 30, 2014

NEW YORK (Reuters Health) - The risk of developing cancer, including prostate cancer, is not elevated in men who receive long-term testosterone therapy, according to a new registry study.

"Some uncertainly remains about the safety of testosterone regarding prostate health," lead author Dr. Michael L. Eisenberg from Stanford University School of Medicine in Stanford, California, told Reuters Health. "The current report demonstrated that with extensive follow-up there did not appear to be any increased risk of prostate cancer for men on testosterone."

Several longitudinal studies have found no association between baseline testosterone levels and prostate carcinogenesis. And an earlier meta-analysis of 19 placebo-controlled trials failed to show a higher risk of prostate cancer in men on testosterone therapy. But a short follow-up of these trials may have limited their ability to detect a long-term risk, Dr. Eisenberg and colleagues write in BJU International, online October 20.

The researchers linked 247 men treated with testosterone therapy over the past 20 years (and 211 untreated controls) with the Texas Cancer Registry to examine the association between cancer incidence (prostate and others) and testosterone therapy.

Overall, 47 men developed cancer, including 8.1% of men on testosterone therapy and 12.8% of men not on testosterone therapy (p=0.1), the team found.

These rates were higher than expected for the general Texas population, and the excess risk seemed to be explained entirely by a threefold higher-than-expected number of prostate cancer cases.

Neither the overall cancer incidence (hazard ratio, 1.0) nor the prostate cancer risk (HR, 1.2) differed significantly by treatment group. And there was no significant difference in the prostate biopsy rates between men who did and did not take testosterone (25.9% vs. 31.8%, p=0.17).

What did seem to contribute to prostate cancer risk, though, was the baseline PSA level. Men below the median 1.1 ng/mL had no altered risk of prostate cancer regardless of testosterone therapy, whereas men above the median had a prostate cancer risk 3.51 times higher, also regardless of testosterone therapy.

"I think providers should be mindful of the fact that prostate cancer risk varies with PSA level," Dr. Eisenberg said. "But our data did not demonstrate that testosterone changed that risk, just that a higher PSA makes it more likely for a man to be diagnosed (whether or not he's on testosterone)."

"As we continue to evaluate the risks of and benefits of testosterone supplementation therapy, it's important to have a balanced view not only of the harms but also of the lack of harms caused by these treatments," he concluded.

SOURCE: http://bit.ly/1wCquHF

BJU Int 2014.

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