title: A survey of Canadian urologists' opinions and prescribing patterns of testosterone replacement therapy in men on active surveillance for low-risk prostate cancer.
abstract: BACKGROUND
  Attitudes regarding the safety of testosterone replacement therapy (TRT) in hypogonadal men with prostate cancer (PCa) have changed over the past few years with the emergence of case studies suggesting a low risk of cancer progression and a better understanding of the interaction of different levels of androgen with prostate cellular metabolism. This new view has the potential to change clinical practice.
  
  
  METHODS
  Active members of the Canadian Urological Association were surveyed about their opinions on the safety of TRT in men with low-risk PCa, as well as their current prescribing habits.
  
  
  RESULTS
  Of 57 responding urologists, 86% actively prescribe TRT in men with testosterone deficiency syndrome (TDS), 93% are involved in the treatment of men with PCa, and 95% offer active surveillance as a management option for low-grade/low-stage disease. Furthermore, 65% stated that they would offer TRT to men with TDS who were on active surveillance for PCa and 63% believed that TRT did not increase the risk of progression of PCa in these men. In terms of treatment methods, 96% believed TRT was safe for men who have undergone radical prostatectomy, while a smaller number felt it was safe for patients who have undergone brachytherapy (86%) or external beam radiation (84%). Despite these figures, only 35% of the surveyed physicians had ever offered TRT for men on active surveillance and only 42% actually had men in their practice who were taking testosterone while on active surveillance.
  
  
  CONCLUSIONS
  The discrepancy between urologists' beliefs about the safety of TRT and their clinical practice patterns may be due to multiple factors, such as hesitation in recommending treatment in real-life practice, low numbers of eligible patients, absence of screening for testosterone deficiency in patients on active surveillance, and patient preference or fears. Furthermore, the difference in perceived safety in men treated by radical prostatectomy vs. radiation therapy suggests that some urologists are concerned that the radiated gland remaining in-situ may be "reactivated" by TRT. The results from this survey will be used as the basis of developing a national Canadian registry of men with low-grade/stage PCa who are receiving TRT while on active surveillance.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Millar
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada.
authors.forename: Dean S
authors.initials: DS
authors.lastname: Elterman
authors.affiliation: Department of Urologic Sciences, University of British Columbia Vancouver, BC, Canada.
authors.forename: Larry
authors.initials: L
authors.lastname: Goldenberg
authors.affiliation: Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Brandon
authors.initials: B
authors.lastname: Van Asseldonk
authors.affiliation: Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Ashley
authors.initials: A
authors.lastname: Curtis
authors.affiliation: Division of Urology, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Keith
authors.initials: K
authors.lastname: Jarvi