Replacement therapy with testosterone gel in patients undergoing radical retropubic prostatectomy

Maurizio Carrino1, Luigi Pucci1, Riccardo Giannella1, Fausto Monaco1, Daniele Mattace Raso1, Andrea Oliva1, Paolo Fedelini1
  • 1 AORN A. Cardarelli - U.O.S. Andrologia Chirurgica (Napoli)

Objective

The effectiveness of testosterone replacement therapy in patients selected according to the criteria of the Massachusetts Male Aging Study is widely supported by the literature of the past five years. In the U.S. there has been an increase in prescriptions of approx. 90% for at least 2 Billion dollars. At the same time numerous authors have certified security in terms of assumed inducer of prostate cancer, in particular with the theory of receptor saturation according to Morgentaler. But how to act in stable patients treated with radical prostatectomy with hypogonadism? We report the results obtained in a group of 18 patients with stable disease after radical prostatectomy and a clinical picture of hypogonadism treated with testosterone gel.

Methods and results

From January 2011 to December 2012 were selected 24 patients (mean age 63.68 AA) underwent radical prostatectomy and symptoms of hypogonadism in which was proposed therapy with testosterone gel 2% by informing about the benefits and potential risks. 6 patients refused treatment. The inclusion criteria in the 18 patients were: symptoms of hypogonadism, testosterone < 300ng/dl , PSA < 0.1 ng / dl , pT2N0 disease with negative margins , Gleason score < 7 first number 3 . All were subjected to thorough clinical evaluation to rule out other contraindications for TRT ( sleep apnea, polycythemia , chronic liver disease , severe hypertension and heart failure ) . PSA , complete blood count and total testosterone were repeated on the 3rd , 6th and 12th month . The T.R.T. began on average at 26 months post-operatively and was conducted with 2 % testosteron gel 60mg daily in three divided doses.
In 15 of 18 patients at 12 months was found a significant improvement in the quality of life score ( 8 patients previously treated for ED or sexual discomfort increased their use of therapeutic aids adopted) and a mean increase in total testosterone from 255 ng / dL to 427 ng / dl. In 3 patients has not been observed improvement of the score despite normal levels of testosterone. In no patient was found serological evidence of disease progression . In 1 patient reported a transient increase in PSA at month 3 ( 0.02 to 0.05 ) returned spontaneously in pre- treatment value.

Discussion

The T.R.T. in patients who had undergone radical prostatectomy for localized prostate adenocarcinoma is still controversial because of the different currents of thought that we can find in the literature. It was calculated that to detect a 20% increase in the rate of relapse with a reliability of 80% and a significance of 5% would require a sample of 85 862 patients observed for at least 12 months. Although our results are in line with those of many authors that consider safe the TRT after radical prostatectomy, it should be carefully discussed with the patient at the time and used only in patients with "good prognosis with a low risk of recurrence.

Argomenti: