INTRODUCTION: Controversy exists regarding testosterone replacement therapy (TRT) in men following radical prostatectomy (RP). Many clinicians are hesitant to offer patients TRT after an RP, out of concern that the increased androgen levels may promote tumor progression or recurrence from residual tumor. Recently, several small studies have demonstrated the use of TRT in men following an RP and have shown an improvement in serum testosterone levels with no increase in prostate-specific antigen (PSA) values. AIMS: The aim of this article is to assess changes in PSA and testosterone values in hypogonadal patients on TRT after RP and also to evaluate the impact of pathologic Gleason grade on ultimate PSA values. METHODS: All hypogonadal men who were treated with TRT by members of our department following RP were retrospectively reviewed. PSA values before RP, after RP, and after TRT were evaluated. Serum testosterone levels before and after TRT were also examined. Only patients with undetectable PSA values and negative surgical margins on pathologic specimen were offered TRT and included in the study. MAIN OUTCOME MEASURES: Main outcome measures were changes in PSA and testosterone values after initiation of TRT. RESULTS: Fifty-seven men, ages 53-83 years (mean 64), were identified as having initiated TRT following RP. Men received TRT for an average of 36 months following RP (range 1-136 months). Patients were followed an average of 13 months after initiation of TRT (range 1-99 months). The mean testosterone values rose from 255 ng/dL before TRT to 459 ng/dL after TRT (P < 0.001). There was no increase in PSA values after initiation of TRT and thus no patient had a biochemical PSA recurrence. CONCLUSION: TRT is effective in improving testosterone levels, without increasing PSA values, in hypogonadal men who have undergone RP.
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机译：简介：关于男性前列腺癌根治术（RP）后的睾丸激素替代疗法（TRT）存在争议。由于担心雄激素水平升高可能促进肿瘤进展或残留肿瘤复发，许多临床医生不愿在RP后为患者提供TRT。最近，一些小型研究表明，RP后男性使用TRT，并显示血清睾丸激素水平有所改善，而前列腺特异性抗原（PSA）值却没有增加。目的：本文的目的是评估RP后TRT下性腺功能减退患者的PSA和睾丸激素值的变化，并评估病理性格里森评分对最终PSA值的影响。方法：回顾性分析所有在RP后由本科成员接受TRT治疗的性腺功能减退男性。评估RP之前，RP之后和TRT之后的PSA值。还检查了TRT前后的血清睾丸激素水平。仅向PSA值未检出且病理标本的手术切缘阴性的患者提供TRT并纳入研究。主要观察指标：主要观察指标是开始TRT后PSA和睾丸激素值的变化。结果：57名年龄在53-83岁（平均64岁）的男性被确定为在RP后开始进行TRT。男性在接受RP之后平均接受TRT治疗36个月（范围1-136个月）。开始TRT后平均随访13个月（范围1-99个月）。平均睾丸激素值从TRT前的255 ng / dL上升到TRT后的459 ng / dL（P <0.001）。开始TRT后PSA值没有增加，因此没有患者发生生化PSA复发。结论：TRT可有效地降低性腺功能减退男性的睾丸激素水平，而不增加其PSA值。
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