title: Outcomes of Prostate Biopsy in Men with Hypogonadism Prior or During Testosterone Replacement Therapy.
abstract: BACKGROUND
  The relationship between Testosterone Replacement Therapy (TRT) and prostate cancer remains controversial. Most TRT studies show no change in prostate specific antigen (PSA) but some men do have PSA rise or develop an abnormal digital rectal exam (aDRE). Our objective was to examine the biopsy results of men with symptomatic hypogonadism before or during therapy.
  
  
  METHODS
  Data was extracted from our medical record on men with hypogonadism who had a prostate biopsy within the past 4 years done by 3 Urologists with guideline driven practice patterns.
  
  
  RESULTS
  96 men were identified. Mean age at biopsy was 63 (range 40-85) and median PSA was 3.78ng/dL (0.5-662). Of the 61 men not on TRT, median PSA was 4.34 (0.5 to 662) and mean total testosterone 254 (191-341). There were 29 (47.5%) prostate cancers found (6 Gleason score 6, 13 Gleason score 7, 10 Gleason score 8 or 9). Of the 35 men on TRT, median PSA was 3.27 (0.5 to 13.7). The %PSA increase ranged from 2 to 251% (mean 93.5%). Mean total testosterone was 383 (146-792). Of the 14 men treated < 2 years, none had cancer. Of the 21 men treated 2 or more years 5 had cancer (2 Gleason score 6, 3 Gleason score 7).
  
  
  CONCLUSIONS
  Men with hypogonadism and a clinical indication for biopsy often have prostate cancer, many high grade. No men with an initial PSA rise on TRT had cancer. Men on long term TRT should be monitored with PSA and DRE per guidelines.
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Shoskes
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Yagil
authors.initials: Y
authors.lastname: Barazani
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Khaled
authors.initials: K
authors.lastname: Fareed
authors.affiliation: Department of Urology, Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Edmund
authors.initials: E
authors.lastname: Sabanegh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001706:Biopsy; D005058:Eunuchism / Q000097:blood / Q000188:drug therapy* / Q000473:pathology*; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013739:Testosterone / Q000097:blood / Q000627:therapeutic use*
chemical_list: D013739:Testosterone; D017430:Prostate-Specific Antigen