One thousand three hundred sixty-five men aged 28–87 (mean 55) years with symptomatic androgen deficiency and receiving testosterone replacement therapy- TRT have been monitored for up to 20 years. All patients were prescreened for prostate cancer by digital rectal exam and prostatic specific antigen-PSA along with endocrine, biochemical, hematological, and urinary profiles at baseline and every 6 months. Abnormal findings or rising PSA were investigated by transrectal ultrasound and prostate biopsy. The data were compared for the four different testosterone preparations used in TRT, including pellet implants, Restandol, mesterolone, and Testogel.
The incidence of prostate cancer during long-term TRT was equivalent to that expected in the general population. This study adds to the considerable weight of evidence that with proper clinical monitoring, testosterone treatment is safe for the prostate and improves early detection of PCa. Testosterone treatment with regular monitoring of the prostate may be safer for the individual than any alternative without surveillance.