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- Title
Prostate Safety Events During Testosterone Replacement Therapy in Men With Hypogonadism: A Randomized Clinical Trial.
- Authors
Bhasin, Shalender; Travison, Thomas G.; Pencina, Karol M.; O'Leary, Michael; Cunningham, Glenn R.; Lincoff, A. Michael; Nissen, Steven E.; Lucia, M. Scott; Preston, Mark A.; Khera, Mohit; Khan, Nader; Snabes, Michael C.; Li, Xue; Tangen, Catherine M.; Buhr, Kevin A.; Thompson Jr, Ian M.
- Abstract
Key Points: Question: Does testosterone replacement therapy in men with hypogonadism increase the risk of high-grade or any prostate cancer or other adverse prostate events? Findings: During 14 304 person-years of follow-up of 5204 men (aged 45-80 years) with hypogonadism in this randomized clinical trial, incidences of high-grade or any prostate cancer, acute urinary retention, invasive surgical procedures, and new pharmacologic treatment were low and did not differ significantly between groups. Meaning: The study's findings will facilitate a more informed appraisal of the potential prostate risks of testosterone replacement therapy. This randomized clinical trial examines the effects of testosterone replacement therapy on major adverse cardiovascular events in men with hypogonadism. Importance: The effect of testosterone replacement therapy (TRT) on the risk of prostate cancer and other adverse prostate events is unknown. Objective: To compare the effect of TRT vs placebo on the incidences of high-grade prostate cancers (Gleason score ≥4 + 3), any prostate cancer, acute urinary retention, invasive prostate procedures, and pharmacologic treatment for lower urinary tract symptoms in men with hypogonadism. Design, Setting, and Participants: This placebo-controlled, double-blind randomized clinical trial enrolled 5246 men (aged 45-80 years) from 316 US trial sites who had 2 testosterone concentrations less than 300 ng/dL, hypogonadal symptoms, and cardiovascular disease (CVD) or increased CVD risk. Men with prostate-specific antigen (PSA) concentrations greater than 3.0 ng/mL and International Prostate Symptom Score (IPSS) greater than 19 were excluded. Enrollment took place between May 23, 2018, and February 1, 2022, and end-of-study visits were conducted between May 31, 2022, and January 19, 2023. Intervention: Participants were randomized, with stratification for prior CVD, to topical 1.62% testosterone gel or placebo. Main Outcomes and Measures: The primary prostate safety end point was the incidence of adjudicated high-grade prostate cancer. Secondary end points included incidence of any adjudicated prostate cancer, acute urinary retention, invasive prostate surgical procedure, prostate biopsy, and new pharmacologic treatment. Intervention effect was analyzed using a discrete-time proportional hazards model. Results: A total of 5204 men (mean [SD] age, 63.3 [7.9] years) were analyzed. At baseline, the mean (SD) PSA concentration was 0.92 (0.67) ng/mL, and the mean (SD) IPSS was 7.1 (5.6). The mean (SD) treatment duration as 21.8 (14.2) months in the TRT group and 21.6 (14.0) months in the placebo group. During 14 304 person-years of follow-up, the incidence of high-grade prostate cancer (5 of 2596 [0.19%] in the TRT group vs 3 of 2602 [0.12%] in the placebo group; hazard ratio, 1.62; 95% CI, 0.39-6.77; P =.51) did not differ significantly between groups; the incidences of any prostate cancer, acute urinary retention, invasive surgical procedures, prostate biopsy, and new pharmacologic treatment also did not differ significantly. Change in IPSS did not differ between groups. The PSA concentrations increased more in testosterone-treated than placebo-treated men. Conclusions and Relevance: In a population of middle-aged and older men with hypogonadism, carefully evaluated to exclude those at high risk of prostate cancer, the incidences of high-grade or any prostate cancer and other prostate events were low and did not differ significantly between testosterone- and placebo-treated men. The study's findings may facilitate a more informed appraisal of the potential risks of TRT. Trial Registration: ClinicalTrials.gov Identifier: NCT03518034
- Subjects
HYPOGONADISM; CARDIOVASCULAR diseases risk factors; PATIENT aftercare; STATISTICS; HORMONE therapy; BIOPSY; CONFIDENCE intervals; TESTOSTERONE; OPERATIVE surgery; URINARY tract infections; LIQUID chromatography-mass spectrometry; TREATMENT duration; RISK assessment; RANDOMIZED controlled trials; PLACEBOS; BLIND experiment; PHARMACEUTICAL gels; DESCRIPTIVE statistics; MEDICAL referrals; RESEARCH funding; RETENTION of urine; STATISTICAL sampling; PROSTATE-specific antigen; DATA analysis; SENSITIVITY &; specificity (Statistics); PROSTATE tumors; TUMOR grading; PROSTATE diseases; DISEASE risk factors; SYMPTOMS
- Publication
JAMA Network Open, 2023, Vol 6, Issue 12, pe2348692
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.48692