The Benefits of Testosterone Treatment in Prostate Cancer

Letters to the editor regarding the article The Probability of Remaining Under Active Surveillance for Localized Prostate Cancer An Analysis of Young Patients in the Framework of the Multicenter ProjuMa Registry Study by Kevin Claassen, Christina Justenhoven, Silke Hermann, Jana Brandhorst, Jale Lakes, Dominique Werner, Hiltraud Kajüter, Madeleine Karpinski, Volker Arndt, Andreas Stang, and Peter Albers in issue 15/2025

The prerequisites for active surveillance included a maximum PSA measurement of 10 ng/mL and a Gleason score of 6 or less (1). In 47.3% of patients from Baden-Württemberg, the PSA value was not known. 52% of patients changed to active treatment without a clear clinical rationale, making the rate of 2-year active surveillance low compared to international studies. In addition to including a standardized evaluation of an initial magnetic resonance imaging (MRI) scan to enroll in active surveillance in future studies, the documentation of serum testosterone concentrations, prostate volumes, ethnic background (men with dark skin have a higher risk of dying from prostate cancer), and the intake of finasteride/dutasteride could / may be important.

Testosterone treatment is not associated with an increased risk of prostate cancer. This was recently shown in the TRAVERSE Trial, where the baseline serum testosterone concentration was 227 ng/dL and the median testosterone therapy concentration was 371 ng/dL (2). The saturation model showed maximal stimulation of prostate tissue for a serum testosterone concentration of 250 ng/dL (8 mmol/L)—meaning that the PSA value may be measured falsely low when serum testosterone concentrations are below 250 ng/dL (3). Approximately 15% of men with testosterone deficiency and a PSA measurement below 4 ng/mL have biopsy proven prostate cancer. 5-alpha reductase inhibitors reduce serum PSA by 50% (3). In contrast to the established school of thought, patients with prostate cancer can undergo testosterone treatment with often dramatic improvement in life energy (3, 4). In patients under active surveillance, the baseline PSA value was 3.29–5.66 ng/mL, with a serum testosterone concentration of 238–328 ng/dL. After starting testosterone therapy the PSA value was 3.6–4.31 ng/mL with a serum testosterone concentration of 664 ng/dL (4).

DOI: 10.3238/arztebl.m2025.0193

Prof. Dr. med. habil. Christian A. Koch

Prof. Dr. Joe M. Chehade

Department of Medicine, University of Florida

Jacksonville, FL, U.S.A.

References

1. Claassen K, Justenhoven C, Hermann S, et al.: The probability of remaining under active surveillance for localized prostate cancer: An analysis of young patients in the framework of the multicenter ProjuMa registry study. Dtsch Arztebl Int 2025; 122: 401–5

2. Khera M, Orozco Rendon D, Saffati G, Morgentaler A: Lessons learned from the TRAVERSE trial. J Sex Med 2024; 21: 746–8

3. Morgentaler A, Conners WP: Testosterone therapy in men with prostate cancer: Literature review, clinical experience, and recommendations. Asian j Androl 2015; 17: 206–11

4. Kaplan AL, Hu JC, Morgentaler A, Mulhall JP, Schulman CC, Montorsi F: Testosterone therapy in men with prostate cancer. Eur Urol 2016; 69: 894–903