1. ¹Division of Urology, Maimonides Medical Center, Brooklyn, College of Physicians & Surgeons of Columbia University, New York, NY, USA
2. ²Division of Urologic Oncology, University of Colorado Health Sciences Center, Aurora, CO, USA
3. ³Department of Urology, Mayo Medical School, Mayo Clinic, Rochester, MN, USA
4. ⁴Department of Urology, Baylor College of Medicine, Memorial Hermann Hospital—TMC, Vanguard Urologic Institute and Texas Prostate Center, Houston, TX, USA

Correspondence: Dr R Shabsigh, Division of Urology, Maimonides Medical Center, 904 49th Street, Brooklyn, NY 11219, USA. E-mail: rshabsigh@maimonidesmed.org

Received 8 April 2008; Revised 3 June 2008; Accepted 4 June 2008; Published online 11 September 2008.

Abstract

This paper provides a systematic review of the literature about prostate cancer risk associated with testosterone therapy for hypogonadism. A comprehensive search of MEDLINE, EMBASE and other resources was conducted to identify articles that highlight occurrences of prostate cancer in men receiving testosterone therapy for hypogonadism treatment. Articles that met study inclusion criteria were assessed for causality between testosterone treatment and prostate cancer, increased prostate-specific antigen or abnormal digital rectal examination findings. Of 197 articles relating to testosterone therapy, 44 met inclusion criteria: 11 placebo-controlled, randomized studies; 29 non-placebo-controlled studies of men with no prostate cancer history; and 4 studies of hypogonadal men with history of prostate cancer. Of studies that met inclusion criteria, none demonstrated that testosterone therapy for hypogonadism increased prostate cancer risk or increased Gleason grade of cancer detected in treated vs untreated men. Testosterone therapy did not have a consistent effect on prostate-specific antigen levels.