THERAPY AND CLINICAL FEARS
Testosterone therapy, used to treat testosterone deficiency in many men worldwide, has long been a subject of debate due to its possible link with prostate cancer. The fear that it may increase the risk of developing this disease has led many doctors to avoid prescribing it, especially to men with a family history of prostate cancer, who are therefore considered more vulnerable. However, a recent study published in BMJ Oncology analyzed precisely this high-risk group, with results that could change the clinical approach.
THE STUDY ON AT-RISK PATIENTS
The decision was made to analyze data from over 120 million U.S. patients collected in the TriNetX database, focusing on men with low testosterone levels and a documented family history of prostate cancer. It's like having a large magnifying glass to observe what happens when testosterone is administered to people who may already be predisposed to developing this type of cancer.
Two groups were compared: 623 men treated with testosterone replacement therapy and 623 who did not receive it, balanced for baseline clinical characteristics. The observation lasted ten years and focused both on the incidence of prostate cancers and on the need for active treatments such as surgery or radiotherapy.
KEY FINDINGS
The results indicate that there was no significant increase in the risk of prostate cancer diagnosis in the treated group compared to the untreated group (6.26% vs. 5.46%). Similarly, the use of cancer treatments showed no relevant differences (2.73% vs. 3.69%). A more in-depth analysis revealed a possible reduction in risk in the early years, followed by an increase in cumulative incidence at ten years (21.7% in the testosterone group compared to 12.4%), although this difference was not statistically significant.
CONCLUSIONS AND PERSPECTIVES
It is emphasized that, although this is a retrospective study with some limitations (such as the absence of data on tumor stage and aggressiveness), the results are encouraging. They suggest that testosterone therapy may be safe even in men with a family history of prostate cancer, at least in the medium term.
SIGNED BY THE RESEARCH
The study conducted by Dr. Edoardo Pozzi, a researcher at URI, demonstrates how this research not only helps to dispel some fears related to testosterone therapy but also represents an important basis for offering more personalized care to men who could benefit from this treatment, even when they have a familial predisposition to prostate cancer. Further studies will be necessary to confirm these data and to better evaluate the long-term effects.
Pozzi E, Able CA, Kohn T, Kava BR, Montorsi F, Salonia A. Incidence of prostate cancer in men with testosterone deficiency and a family history of prostate cancer receiving testosterone therapy: a comparative study. BMJ Oncol. 2025 Mar 6;4(1):e000520. doi: 10.1136/bmjonc-2024-000520. PMID: 40099006; PMCID: PMC11911667.
