Use of Testosterone Replacement Therapy after Radical Prostatectomy Might Kill Two Birds with One Stone from the Perspective of Men’s Health and Disease Control

Main Article Content

Jong Kil Nam
Ki Soo Lee
Tae Nam Kim


Testosterone, Prostate Cancer, Men’s Health, Recurrence, Prostatectomy


Testosterone plays an important role in promoting the differentiation and stimulation of prostate epithelial cells. Adding to the basic physiology of testosterone, several studies led to the dissemination of the historical androgen hypothesis that higher circulating androgen levels promote prostate cancer cell growth and make the tumor more aggressive. Whereas, the prostate saturation model accounted for the androgen sensitivity of testosterone stimulation in the prostate up to a saturation point, which occurred near the level of castration. Testosterone is related to prostate cancer metabolism in a complex manner; however, within the reference range, high or normal testosterone levels are expected to maintain benign and malignant prostate cells in a differentiated state. Accumulating evidence has suggested that testosterone replacement therapy (TRT) might prevent the development of prostate cancer and even reduce prostate cancer risk. There is no change in the clinical guidelines to be followed when considering TRT in patients with a history of prostate cancer, but it is necessary for the physician to inform patients of the positive effects of TRT on male health and prostate cancer.


Download data is not yet available.
Abstract 119 | PDF Downloads 60 XML Downloads 0 HTML Downloads 7


1. Fujita K, Nonomura N. Role of androgen receptor in prostate cancer: A review. World J Mens Health 2019;37(3):288–95. wjmh.180040
2. Huggins C, Hodges CV. Studies on prostatic cancer. The effect of castration, of estrogen and androgen injection on serum phosphatases in metastatic carcinoma of the prostate. CA Cancer J Clin 1972;22(4):232–40. canjclin.22.4.232
3. Gann PH, Hennekens CH, Ma J, et al. Prospective study of sex hormone levels and risk of prostate cancer. J Natl Cancer Inst 1996;88(16):1118–26.
4. Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate cancer: The saturation model and the limits of androgen-dependent growth. Eur Urol 2009;55(2):310–20. https://doi. org/10.1016/j.eururo.2008.09.024
5. Wang K, Chen X, Bird VY, et al. Association between age-related reductions in testosterone and risk of prostate cancer—An analysis of patients’ data with prostatic diseases. Int J Cancer 2017;141(9):1783–93. 30882
6. Mearini L, Zucchi A, Nunzi E, et al. Low serum testosterone levels are predictive of prostate cancer. World J Urol 2013;31(2):247–52. https://doi. org/10.1007/s00345-011-0793-x
7. Shin BS, Hwang EC, Im CM, et al. Is a decreased serum testosterone level a risk factor for prostate cancer? A cohort study of Korean men. Korean J Urol 2010;51(12):819–23. kju.2010.51.12.819
8. Tafuri A, Sebben M, Shakir A, et al. Endogenous testosterone mirrors prostate cancer aggressiveness: Correlation between basal testosterone serum levels and prostate cancer European Urology Association clinical risk classes in a large cohort of Caucasian patients. Int Urol Nephrol 2020;52(7):1261-9.
9. Schatzl G, Madersbacher S, Haitel A, et al. Associations of serum testosterone with microvessel density, androgen receptor density and androgen receptor gene polymorphism in prostate cancer. J Urol 2003;169(4):1312–5. 10.1097/01.ju.0000056900.26628.16
10. Lane BR, Stephenson AJ, Magi-Galluzzi C, et al. Low testosterone and risk of biochemical recurrence and poorly differentiated prostate cancer at radical prostatectomy. Urology 2008;72(6):1240–5.
11. Massengill JC, Sun L, Moul JW, et al. Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy. J Urol 2003;169(5): 1670–5. 43964.d0
12. Ferro M, Lucarelli G, Bruzzese D, et al. Low serum total testosterone level as a predictor of upstaging and upgrading in low-risk prostate cancer patients meeting the inclusion criteria for  active surveillance. Oncotarget 2017;8(11): 18424–34. 12906
13. Calof OM, Singh AB, Lee ML, et al. Adverse events associated with testosterone replacement in middle-aged and older men: A meta-analysis of randomized, placebo-controlled trials. J Gerontol A 2005;60(11):1451–7. gerona/60.11.1451
14. Eaton NE, Reeves GK, Appleby PN, et al. Endogenous sex hormones and prostate cancer: A quantitative review of prospective studies. Br J Cancer 1999;80(7):930–4. sj.bjc.6690445
15. Wallis CJ, Lo K, Lee Y, et al. Survival and cardiovascular events in men treated with testosterone replacement therapy: An intention-to-treat observational cohort study. Lancet Diabetes Endocrinol 2016;4(6):498–506.
16. Loeb S, Folkvaljon Y, Damber JE, et al. Testosterone replacement therapy and risk of favorable and aggressive prostate cancer. J Clin Oncol 2017;35:1430–6. JCO.2016.69.5304
17. Kaplan AL, Hu JC. Use of testosterone replacement therapy in the United States and its effect on subsequent prostate cancer outcomes. Urology 2013;82(82):321–6. 2013.03.049
18. Kardoust Parizi M, Abufaraj M, Fajkovic H, et al. Oncological safety of testosterone replacement therapy in prostate cancer survivors after definitive local therapy: A systematic literature review and meta-analysis. Urol Oncol 2019;37(10):637–46.
19. Klap J, Schmid M, Loughlin KR. The relationship between total testosterone levels and prostate cancer: A review of the continuing controversy. J Urol 2015;193(2):403–13. juro.2014.07.123
20. Pastuszak AW, Pearlman AM, Lai WS, et al. Testosterone replacement therapy in patients with prostate cancer after radical prostatectomy. J Urol 2013;190(2):639–44. juro.2013.02.002
21. Ahlering TE, Huynh LM, Towe M, et al. Testosterone replacement therapy reduces bio-chemical recurrence post-radical prostatectomy. BJU Int 2020;2.
22. Hackett G. Type 2 diabetes and testosterone therapy. World J Mens Health 2019;37(1):31–44.
23. Nam YS, Lee G, Yun JM, et al. Testosterone replacement, muscle strength, and physical function. World J Mens Health 2018;36(2):110–22.
24. Bell MA, Campbell JD, Joice G, et al. Shifting the paradigm of testosterone replacement therapy in prostate cancer. World J Mens Health 2018;36(2):103–9. 170007