The clinician briefly outlines the studies that suggest testosterone therapy may significantly improve symptoms of hypogonadism, including ED, following radical prostatectomy in certain patients.

A seminal paper by Kaufman and Graydon documented the experience of two urology practices with the use of testosterone therapy to treat hypogonadal men who had undergone curative radical prostatectomy for localized prostate cancer.1 This retrospective review of the clinical records of 7 hypogonadal men who had undergone curative radical prostatectomy showed no biochemical or clinical evidence of cancer recurrence.

A study by Agarwal and Oefelein showed that, in 10 hypogonadal patients previously treated with radical retropubic prostatectomy (RRP) for organ-confined prostate cancer who presented with low serum total testosterone and symptoms of hypogonadism, testosterone therapy was safe and effective.2 At follow-up (mean, 19 months), no patient had detectable prostate-specific antigen (>0.1 ng/mL), a marker associated with prostate cancer. Total testosterone level increased significantly after starting therapy, with a statistically significant improvement in hypogonadal symptoms. The results suggested that testosterone therapy may be administered carefully to certain hypogonadal patients with prostate cancer following RRP.

The clinician provides the patient with educational materials and references, including Testosterone for Life, by Abraham Morgentaler, MD.3

Clinical comment: Patient selection is critical. It is necessary to ascertain that a patient is motivated, intelligent, and likely to be extremely adherent to a treatment regimen and follow-up schedule.

References
  1. Kaufman JM, Graydon RJ. Androgen replacement after curative radical prostatectomy for prostate cancer in hypogonadal men [review]. J Urol. 2004;172(3):920-922.
  2. Agarwal PK, Oefelein MG. Testosterone replacement therapy after primary treatment for prostate cancer. J Urol. 2005;173(2):533-536.
  3. Morgentaler A. Testosterone for Life: Recharge Your Vitality, Sex Drive, Muscle Mass, and Overall Health. New York, NY: McGraw-Hill; 2008.


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