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Untreated hypogonadism and testosterone replacement therapy in hypogonadal men are associated with a decreased risk of subsequent prostate cancer: a population-based study

International Journal of Impotence Research (2024)Cite this article

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Abstract

We sought to understand the relationship between hypogonadism and testosterone replacement therapy (TRT) in hypogonadal men on the risk of developing localized and metastatic prostate cancer. We used the Merative MarketScan database of commercial claims encounters to identify men diagnosed with hypogonadism. These men were matched to eugonadal men who served as controls. Multivariate negative binomial regression analysis of prostate cancer diagnoses, hypogonadism, and TRT in hypogonadal men adjusting for various known confounding factors was used to understand the impact of hypogonadism and TRT on prostate cancer risk. We identified 3,222,904 men who met inclusion criteria, of which 50% were diagnosed with hypogonadism (1,611,452) and each were matched to a control (1,611,452). The incidence of prostate cancer was 2.16%, 1.55%, and 1.99% in eugonadal controls, hypogonadal men on TRT, and hypogonadal men without TRT, respectively (p < 0.001). Untreated hypogonadism was independently associated with a decreased risk of localized prostate cancer (IRR 0.46, 95% CI 0.43–0.50, p < 0.001) compared to eugonadal controls. Hypogonadal men on TRT also had a significantly decreased risk of localized prostate cancer (IRR 0.49, 95% CI 0.45–0.53, p < 0.001). Furthermore, hypogonadal men on TRT (IRR 0.21, 95% CI 0.19–0.24, p < 0.001) or without TRT (IRR 0.20, 95% CI 0.18–0.22, p < 0.001) both had significantly decreased risk of metastatic prostate cancer, respectively. Our population-based analysis suggests that untreated hypogonadism in men is associated with a 50% decreased incidence of localized prostate cancer and an 80% decreased incidence of metastatic prostate cancer. TRT in hypogonadal men was also associated with a decreased risk of subsequent prostate cancer. Further research is needed to better understand the relationship between hypogonadism and TRT in hypogonadal men on the risk of subsequent prostate cancer.

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MarketScan data set is available by request.

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Funding

The computational resources used were partially funded by the NIH, Share Instrumentation Grant 1S10OD021644-011A1.

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Authors and Affiliations

  1. Institute of Urology, University of Southern California, Los Angeles, CA, USA

    Kian Asanad & Mary K. Samplaski

  2. Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT, USA

    Joshua J. Horns & Nathan Driggs

  3. Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA

    James M. Hotaling

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  1. Kian Asanad
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  2. Joshua J. Horns
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  4. Mary K. Samplaski
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  5. James M. Hotaling
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Contributions

Conceptualization, KA, JJ, MKS, JMH. Methodology, KA, JJ, MKS, JMH. Formal Analysis, JJ and ND. Writing – original draft, KA, JJ, MKS, JMH. Writing - reviewing, & editing, KA, JJ, MKS, JMH. Supervision, JMH.

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Correspondence to James M. Hotaling.

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Asanad, K., Horns, J.J., Driggs, N. et al. Untreated hypogonadism and testosterone replacement therapy in hypogonadal men are associated with a decreased risk of subsequent prostate cancer: a population-based study. Int J Impot Res (2024). https://doi.org/10.1038/s41443-023-00820-3

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  • DOI: https://doi.org/10.1038/s41443-023-00820-3

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