Study analysis · BJU International · 2025
Testosterone therapy might be safe for men with prostate cancer after all – new review challenges decades of medical dogma.
A review of 19 studies found that giving testosterone to men with low testosterone and prostate cancer does not seem to increase cancer recurrence or progression rates, but the evidence is still weak.
Overview
What the study found
The study in plain English — the bottom line, every takeaway we extracted, and what to do with them.
In simple terms
This study is like reading a bunch of old patient files to see if testosterone treatment is safe for men with prostate cancer. Because the files weren't kept in a careful, controlled way, we can only see if there's a pattern, not prove that the treatment is safe.
What’s the bottom line?
Doctors reviewed 19 studies to see if giving testosterone to men with low testosterone and prostate cancer is safe. They found that in some men, the cancer did not grow faster, but the studies were not strong enough to be sure.
How strong is this study?
The researchers searched many medical databases and followed a careful process to gather all the studies. However, the studies they found were not high-quality experiments; they were just observations, so we can't fully trust the results until better studies are done.
0 / 100
- COI disclosureconflicts of interest not disclosed
- Data availabilitydata not shared
- Code availabilitycode not shared
0 / 100
- Randomizationrandomization unclear
- Blindingblinding unclear
- Control groupno control group
- Sample sizeno sample size reported
- Follow-upno follow-up reported
100 / 100
0 / 100
- P-valuesno p-values reported
- Effect sizeno effect size reported
- Confidence intervalsno confidence intervals
- Pre-registrationnot pre-registered
Each component is scored out of 100 and then capped by the study design — a case series cannot reach the ceiling a randomised trial can, however well it is reported.
Where it sits
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 520 / 100
Probability of being correct
Systematic reviews and meta-analyses of cohort studies. They sit above a single cohort study but below a single randomized trial, because the underlying evidence is still observational.
This design cannot establish causation — the findings describe an association, not a cause. This is a systematic review of observational (cohort) studies, not randomized controlled trials. The abstract explicitly states 'lack of long-term, prospective, controlled comparative data' and describes the evidence as 'retrospective'. Observational studies cannot establish causation due to potential confounding and selection bias.
COI Unknown
Could not determine conflict of interest status
No conflicts identified from the provided text.
The text is only an abstract; no conflict of interest or funding statements were provided.
Key takeaways
- 01
In men on active surveillance (watching the cancer), progression rates were 0% to 32%, similar to men not on testosterone.
- 02
After surgery, cancer recurrence rates were low (0-7%) over up to 5 years.
- 03
After radiation, recurrence was 0-6%.
- 04
These numbers suggest that testosterone might not be as dangerous as once thought, but the studies are not conclusive because they are small and lack long-term follow-up.
Surprising findings
- Progression rates on active surveillance did not differ between TRT users and non-users.For decades, testosterone was thought to be dangerous in prostate cancer, but this review found no significant difference.
Practical takeaways
If you have low testosterone and low- to intermediate-risk prostate cancer, discuss TRT with your doctor under careful monitoring.
This is based on retrospective data only; no long-term or survival outcomes are available.
low confidenceWhy this study matters
Progression on active surveillance: 0%–32%
In men on active surveillance, cancer progression rates ranged from 0% to 32%, and did not differ significantly from men not receiving testosterone. Follow-up extended up to 70 months.
This challenges the long-held belief that testosterone fuels prostate cancer growth, offering hope to men who suffer from low testosterone symptoms.
Low recurrence after surgery and radiation
After radical prostatectomy, biochemical recurrence rates were 0–7% over up to 60 months; after radiotherapy, 0–6% over the same period.
These rates are similar to or lower than typical recurrence rates without TRT, suggesting TRT may not increase risk.
Caveat: No long-term or survival data
The authors emphasize that evidence is limited by the lack of long-term prospective controlled studies and no assessment of survival outcomes.
Without survival data, we can't be sure TRT doesn't affect long-term outcomes, so caution is still warranted.
Want the whole report?
Detailed mode opens the full scientific breakdown — every score component, the methodology, conflicts of interest, the evidence analysis behind each claim, and the raw study data.
Overview
What the study found
The study in plain English — the bottom line, every takeaway we extracted, and what to do with them.
Not medical advice. For informational purposes only. Always consult a healthcare professional. Terms
Doctors reviewed 19 studies to see if giving testosterone to men with low testosterone and prostate cancer is safe. They found that in some men, the cancer did not grow faster, but the studies were not strong enough to be sure.
Research results
In men on active surveillance (watching the cancer), progression rates were 0% to 32%, similar to men not on testosterone. After surgery, cancer recurrence rates were low (0-7%) over up to 5 years. After radiation, recurrence was 0-6%.
What this means - more context
These numbers suggest that testosterone might not be as dangerous as once thought, but the studies are not conclusive because they are small and lack long-term follow-up.
To evaluate the oncological safety of testosterone replacement therapy (TRT) in hypogonadal patients with prostate cancer.
Systematic review of 19 observational studies assessing progression and biochemical recurrence in men with prostate cancer on TRT. Pooled meta-analysis not possible due to heterogeneity. Progression rates on active surveillance ranged from 0% to 32% and did not differ significantly from non-exposed controls. Biochemical recurrence rates were low post-definitive treatment: 0-7% post-radical prostatectomy and 0-6% post-radiotherapy with up to 60 months follow-up. Certainty limited by lack of long-term prospective controlled data and survival outcome assessment.
Methods Used
Systematic review following PRISMA guidelines; searched Medline, EMBASE, PubMed, Scopus; included 19 studies (5 active surveillance, 10 post-radical prostatectomy, 6 post-radiotherapy).
Main Finding
Progression rates on active surveillance did not differ significantly from non-exposed controls. Biochemical recurrence rates low post-definitive treatment (0-7% post-RP, 0-6% post-radiotherapy) with up to 60 months follow-up.
Confidence Level
Limited - based on abstract only; overall certainty limited by lack of long-term prospective controlled data and survival outcome assessment. Full text not available - methodology details cannot be verified.
Study Flags
Red Flags
- •Full text not available - methodology details cannot be verified
- •Lack of long-term prospective controlled data
- •No assessment of survival outcomes
No biological mechanisms were identified in this study. This may be an epidemiological, observational, or survey-based study that reports associations rather than proposing causal biological pathways.
Surprising Findings
Progression rates on active surveillance did not differ between TRT users and non-users.
For decades, testosterone was thought to be dangerous in prostate cancer, but this review found no significant difference.
Practical Takeaways
If you have low testosterone and low- to intermediate-risk prostate cancer, discuss TRT with your doctor under careful monitoring.
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 520 / 100
Probability of being correct
Systematic reviews and meta-analyses of cohort studies. They sit above a single cohort study but below a single randomized trial, because the underlying evidence is still observational.
Human Systematic Review
Subject
Lower probability
on the GRADE evidence scale
This study is like reading a bunch of old patient files to see if testosterone treatment is safe for men with prostate cancer. Because the files weren't kept in a careful, controlled way, we can only see if there's a pattern, not prove that the treatment is safe.
Strengths
- Systematic review following PRISMA guidelines.
- Multiple databases searched (Medline, EMBASE, PubMed, Scopus).
- Clearly defined inclusion criteria (studies assessing progression and biochemical recurrence in men with prostate cancer and TD receiving TRT).
Weaknesses
- Full methodology not available - based on abstract only.
- Included studies are all observational (cohort), carrying inherent confounding and selection bias.
- Significant clinical and methodological heterogeneity precluded meta-analysis.
Methodology
Evidence Keywords
Statistical Reporting
Not medical advice. For informational purposes only. Always consult a healthcare professional. Terms
Doctors reviewed 19 studies to see if giving testosterone to men with low testosterone and prostate cancer is safe. They found that in some men, the cancer did not grow faster, but the studies were not strong enough to be sure.
Research results
In men on active surveillance (watching the cancer), progression rates were 0% to 32%, similar to men not on testosterone. After surgery, cancer recurrence rates were low (0-7%) over up to 5 years. After radiation, recurrence was 0-6%.
What this means - more context
These numbers suggest that testosterone might not be as dangerous as once thought, but the studies are not conclusive because they are small and lack long-term follow-up.
To evaluate the oncological safety of testosterone replacement therapy (TRT) in hypogonadal patients with prostate cancer.
Systematic review of 19 observational studies assessing progression and biochemical recurrence in men with prostate cancer on TRT. Pooled meta-analysis not possible due to heterogeneity. Progression rates on active surveillance ranged from 0% to 32% and did not differ significantly from non-exposed controls. Biochemical recurrence rates were low post-definitive treatment: 0-7% post-radical prostatectomy and 0-6% post-radiotherapy with up to 60 months follow-up. Certainty limited by lack of long-term prospective controlled data and survival outcome assessment.
Methods Used
Systematic review following PRISMA guidelines; searched Medline, EMBASE, PubMed, Scopus; included 19 studies (5 active surveillance, 10 post-radical prostatectomy, 6 post-radiotherapy).
Main Finding
Progression rates on active surveillance did not differ significantly from non-exposed controls. Biochemical recurrence rates low post-definitive treatment (0-7% post-RP, 0-6% post-radiotherapy) with up to 60 months follow-up.
Confidence Level
Limited - based on abstract only; overall certainty limited by lack of long-term prospective controlled data and survival outcome assessment. Full text not available - methodology details cannot be verified.
Study Flags
Red Flags
- •Full text not available - methodology details cannot be verified
- •Lack of long-term prospective controlled data
- •No assessment of survival outcomes
No biological mechanisms were identified in this study. This may be an epidemiological, observational, or survey-based study that reports associations rather than proposing causal biological pathways.
Surprising Findings
Progression rates on active surveillance did not differ between TRT users and non-users.
For decades, testosterone was thought to be dangerous in prostate cancer, but this review found no significant difference.
Practical Takeaways
If you have low testosterone and low- to intermediate-risk prostate cancer, discuss TRT with your doctor under careful monitoring.
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 520 / 100
Probability of being correct
Systematic reviews and meta-analyses of cohort studies. They sit above a single cohort study but below a single randomized trial, because the underlying evidence is still observational.
Human Systematic Review
Subject
Lower probability
on the GRADE evidence scale
This study is like reading a bunch of old patient files to see if testosterone treatment is safe for men with prostate cancer. Because the files weren't kept in a careful, controlled way, we can only see if there's a pattern, not prove that the treatment is safe.
Strengths
- Systematic review following PRISMA guidelines.
- Multiple databases searched (Medline, EMBASE, PubMed, Scopus).
- Clearly defined inclusion criteria (studies assessing progression and biochemical recurrence in men with prostate cancer and TD receiving TRT).
Weaknesses
- Full methodology not available - based on abstract only.
- Included studies are all observational (cohort), carrying inherent confounding and selection bias.
- Significant clinical and methodological heterogeneity precluded meta-analysis.
Methodology
Evidence Keywords
Statistical Reporting
Scoring
How strong is this study?
The researchers searched many medical databases and followed a careful process to gather all the studies. However, the studies they found were not high-quality experiments; they were just observations, so we can't fully trust the results until better studies are done.
0 / 100
- COI disclosureconflicts of interest not disclosed
- Data availabilitydata not shared
- Code availabilitycode not shared
0 / 100
- Randomizationrandomization unclear
- Blindingblinding unclear
- Control groupno control group
- Sample sizeno sample size reported
- Follow-upno follow-up reported
100 / 100
0 / 100
- P-valuesno p-values reported
- Effect sizeno effect size reported
- Confidence intervalsno confidence intervals
- Pre-registrationnot pre-registered
Each component is scored out of 100 and then capped by the study design — a case series cannot reach the ceiling a randomised trial can, however well it is reported.
Where it sits
RCT reviewsReviews of RCTs (Meta-analyses)
Max 100Randomized TrialsRandomized Trials
Max 90Reviews of Cohort StudiesReviews of Cohort Studies
Max 85Cohort StudiesCohort Studies
Max 72Reviews of Case-Control StudiesReviews of Case-Control Studies
Max 63Case-Control StudiesCase-Control Studies
Max 58Cross-Sectional & Case SeriesCross-Sectional & Case Series
Max 50Expert OpinionExpert Opinion
Max 520 / 100
Probability of being correct
Systematic reviews and meta-analyses of cohort studies. They sit above a single cohort study but below a single randomized trial, because the underlying evidence is still observational.
This design cannot establish causation — the findings describe an association, not a cause. This is a systematic review of observational (cohort) studies, not randomized controlled trials. The abstract explicitly states 'lack of long-term, prospective, controlled comparative data' and describes the evidence as 'retrospective'. Observational studies cannot establish causation due to potential confounding and selection bias.
COI Unknown
Could not determine conflict of interest status
No conflicts identified from the provided text.
The text is only an abstract; no conflict of interest or funding statements were provided.