Study analysis · Asian Journal of Andrology · 2015
Testosterone therapy might not worsen prostate cancer in men on active surveillance, challenging a 70-year-old medical dogma.
In men with low-risk prostate cancer who are closely monitored, taking testosterone for low testosterone levels did not significantly increase the chance of cancer progression over about three years.
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 looked back at medical records of men with low-risk prostate cancer who were not getting treatment right away. Some of these men got testosterone therapy because they had low testosterone, and others didn't. The study found that the men who got testosterone did not seem to have their cancer get worse faster than the men who didn't. But because this was not a carefully controlled experiment, we can only say there might be a connection—we can't be sure testosterone therapy is safe or that it doesn't cause harm.
What’s the bottom line?
Men with low testosterone and low-risk prostate cancer can keep an eye on their cancer instead of treating it right away. This study checked if taking testosterone would make their cancer grow faster. Over about 3 years, men who took testosterone did not have a higher chance of their cancer getting worse than men who didn't take it.
How strong is this study?
Even though the study had a comparison group, it was not as fair as a randomized experiment. The two groups were from different clinics and had slightly different follow-up procedures (like different numbers of biopsy samples taken). Also, there were only 28 men in the testosterone group, which is a small number. Because of these issues, we should not fully trust the study's results to make important decisions without more research.
40 / 100
- COI disclosure+40/40
- Data availabilitydata not shared
- Code availabilitycode not shared
43 / 100
- Randomizationnot randomized
- Blindingblinding unclear
- Control group+15/15
- Sample size (n=124)+9.2/20
- Follow-up+10/10
100 / 100
77 / 100
- P-values+15/15
- Effect size+20/20
- Confidence intervals+15/15
- 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 562 / 100
Probability of being correct
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
This design cannot establish causation — the findings describe an association, not a cause. This is a retrospective cohort study without randomization. Differences between groups (e.g., inclusion of Gleason 3+4 in T group, different biopsy protocols) introduce potential confounding and selection bias. Causal relationships cannot be established; only associations can be observed.
No Conflicts
No conflicts of interest identified
No conflicts identified.
No conflict of interest or funding information provided in the text.
Key takeaways
- 01
About 32% of men taking testosterone had their cancer progress (get a bit worse) compared to 45% of men not taking it.
- 02
Only 11% of men on testosterone had a more serious cancer grade, versus 9% of the others.
- 03
These differences were not big enough to be sure they weren't just due to chance.
- 04
The small number of men in the study means we can't be certain that testosterone is safe, but it suggests it might not be harmful in the short term.
Surprising findings
- Testosterone therapy did not increase biopsy progression rates despite the long-standing belief that testosterone fuels prostate cancer.The 'androgen hypothesis' from 1941 suggested testosterone accelerates prostate cancer, and many physicians still consider prostate cancer an absolute contraindication.
- Men with slightly more aggressive cancer (Gleason 3+4) on testosterone showed no upgrading beyond 3+4 over 2 years.Even in men with a higher baseline risk, testosterone did not appear to worsen their cancer grade.
Practical takeaways
Men with low-risk prostate cancer on active surveillance who have symptoms of low testosterone should discuss testosterone therapy with their doctor, considering the potential benefits and uncertainties.
This study is small and retrospective; individual risks may vary. The study excluded men with higher-volume or higher-risk disease.
low confidenceIf you are on testosterone therapy and diagnosed with low-risk prostate cancer, you may not need to automatically stop testosterone; discuss staying on active surveillance with your urologist.
The study had short follow-up (mean ~3 years); long-term safety is not established.
low confidenceWhy this study matters
No significant increase in cancer progression
Among 28 men on testosterone therapy, 32.1% had biopsy progression compared to 44.7% of 96 untreated men. This difference was not statistically significant (p=0.280).
This reassures men with low testosterone and low-risk prostate cancer that testosterone therapy may not be as dangerous as once thought.
Gleason upgrading rates were similar
Only 10.7% of treated men had an increase in Gleason score versus 9.4% of untreated men (p=0.732).
Gleason score is a key indicator of cancer aggressiveness, and this study suggests testosterone doesn't make the cancer more aggressive.
All treated men reported symptom improvement
Every man in the testosterone group reported improved libido, erectile function, and/or energy levels.
Quality of life improvements are a major reason men seek testosterone therapy, and these benefits occurred without apparent harm.
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
Men with low testosterone and low-risk prostate cancer can keep an eye on their cancer instead of treating it right away. This study checked if taking testosterone would make their cancer grow faster. Over about 3 years, men who took testosterone did not have a higher chance of their cancer getting worse than men who didn't take it.
Research results
About 32% of men taking testosterone had their cancer progress (get a bit worse) compared to 45% of men not taking it. Only 11% of men on testosterone had a more serious cancer grade, versus 9% of the others. These differences were not big enough to be sure they weren't just due to chance.
What this means - more context
The small number of men in the study means we can't be certain that testosterone is safe, but it suggests it might not be harmful in the short term.
To assess whether testosterone therapy increases biopsy progression in testosterone-deficient men on active surveillance for prostate cancer.
Retrospective review of 28 men on testosterone therapy and 96 untreated men with testosterone deficiency on active surveillance. Biopsy progression rates were not statistically different (32.1% vs 44.7%, p=0.280). Gleason upgrading rates were similar (10.7% vs 9.4%, OR 1.16, p=0.732). All treated men reported symptomatic improvement.
Methods Used
Retrospective chart review. 28 men on testosterone therapy (T group) and 96 men with untreated testosterone deficiency (no-T group). Mean follow-up 38.9 and 42.4 months, respectively. Prostate biopsies performed every 12-18 months. Biopsy progression defined as increased Gleason score or increased tumor volume.
Main Finding
Testosterone therapy did not significantly increase biopsy progression or Gleason upgrading in men on active surveillance for low-risk prostate cancer over a mean follow-up of approximately 3 years.
Confidence Level
Moderate: retrospective design, small sample size, and different biopsy protocols between groups (12 vs 20 cores) limit reliability.
Study Flags
Red Flags
- •Retrospective design limits causality
- •Small sample size (28 treated men)
- •Different biopsy protocols between groups (12 vs 20 cores)
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
Testosterone therapy did not increase biopsy progression rates despite the long-standing belief that testosterone fuels prostate cancer.
The 'androgen hypothesis' from 1941 suggested testosterone accelerates prostate cancer, and many physicians still consider prostate cancer an absolute contraindication.
Practical Takeaways
Men with low-risk prostate cancer on active surveillance who have symptoms of low testosterone should discuss testosterone therapy with their doctor, considering the potential benefits and uncertainties.
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 562 / 100
Probability of being correct
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Human Cohort Study
Subject
Moderate probability
on the GRADE evidence scale
This study looked back at medical records of men with low-risk prostate cancer who were not getting treatment right away. Some of these men got testosterone therapy because they had low testosterone, and others didn't. The study found that the men who got testosterone did not seem to have their cancer get worse faster than the men who didn't. But because this was not a carefully controlled experiment, we can only say there might be a connection—we can't be sure testosterone therapy is safe or that it doesn't cause harm.
The study has a COI section but no disclosure was found. A small penalty has been applied.
Strengths
- First large series of testosterone therapy in men on active surveillance including Gleason 3+4 disease
- Includes a comparison group of untreated men with testosterone deficiency
- Relatively long follow-up (mean >3 years)
Weaknesses
- Retrospective design with inherent selection bias
- Small sample size in treatment group (n=28) and especially in Gleason 3+4 subgroup (n=6)
- Different biopsy protocols (12-core vs 20-core) between groups, potentially biasing detection of progression
Methodology
Evidence Keywords
Statistical Reporting
Not medical advice. For informational purposes only. Always consult a healthcare professional. Terms
Men with low testosterone and low-risk prostate cancer can keep an eye on their cancer instead of treating it right away. This study checked if taking testosterone would make their cancer grow faster. Over about 3 years, men who took testosterone did not have a higher chance of their cancer getting worse than men who didn't take it.
Research results
About 32% of men taking testosterone had their cancer progress (get a bit worse) compared to 45% of men not taking it. Only 11% of men on testosterone had a more serious cancer grade, versus 9% of the others. These differences were not big enough to be sure they weren't just due to chance.
What this means - more context
The small number of men in the study means we can't be certain that testosterone is safe, but it suggests it might not be harmful in the short term.
To assess whether testosterone therapy increases biopsy progression in testosterone-deficient men on active surveillance for prostate cancer.
Retrospective review of 28 men on testosterone therapy and 96 untreated men with testosterone deficiency on active surveillance. Biopsy progression rates were not statistically different (32.1% vs 44.7%, p=0.280). Gleason upgrading rates were similar (10.7% vs 9.4%, OR 1.16, p=0.732). All treated men reported symptomatic improvement.
Methods Used
Retrospective chart review. 28 men on testosterone therapy (T group) and 96 men with untreated testosterone deficiency (no-T group). Mean follow-up 38.9 and 42.4 months, respectively. Prostate biopsies performed every 12-18 months. Biopsy progression defined as increased Gleason score or increased tumor volume.
Main Finding
Testosterone therapy did not significantly increase biopsy progression or Gleason upgrading in men on active surveillance for low-risk prostate cancer over a mean follow-up of approximately 3 years.
Confidence Level
Moderate: retrospective design, small sample size, and different biopsy protocols between groups (12 vs 20 cores) limit reliability.
Study Flags
Red Flags
- •Retrospective design limits causality
- •Small sample size (28 treated men)
- •Different biopsy protocols between groups (12 vs 20 cores)
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
Testosterone therapy did not increase biopsy progression rates despite the long-standing belief that testosterone fuels prostate cancer.
The 'androgen hypothesis' from 1941 suggested testosterone accelerates prostate cancer, and many physicians still consider prostate cancer an absolute contraindication.
Practical Takeaways
Men with low-risk prostate cancer on active surveillance who have symptoms of low testosterone should discuss testosterone therapy with their doctor, considering the potential benefits and uncertainties.
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 562 / 100
Probability of being correct
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Human Cohort Study
Subject
Moderate probability
on the GRADE evidence scale
This study looked back at medical records of men with low-risk prostate cancer who were not getting treatment right away. Some of these men got testosterone therapy because they had low testosterone, and others didn't. The study found that the men who got testosterone did not seem to have their cancer get worse faster than the men who didn't. But because this was not a carefully controlled experiment, we can only say there might be a connection—we can't be sure testosterone therapy is safe or that it doesn't cause harm.
The study has a COI section but no disclosure was found. A small penalty has been applied.
Strengths
- First large series of testosterone therapy in men on active surveillance including Gleason 3+4 disease
- Includes a comparison group of untreated men with testosterone deficiency
- Relatively long follow-up (mean >3 years)
Weaknesses
- Retrospective design with inherent selection bias
- Small sample size in treatment group (n=28) and especially in Gleason 3+4 subgroup (n=6)
- Different biopsy protocols (12-core vs 20-core) between groups, potentially biasing detection of progression
Methodology
Evidence Keywords
Statistical Reporting
Scoring
How strong is this study?
Even though the study had a comparison group, it was not as fair as a randomized experiment. The two groups were from different clinics and had slightly different follow-up procedures (like different numbers of biopsy samples taken). Also, there were only 28 men in the testosterone group, which is a small number. Because of these issues, we should not fully trust the study's results to make important decisions without more research.
40 / 100
- COI disclosure+40/40
- Data availabilitydata not shared
- Code availabilitycode not shared
43 / 100
- Randomizationnot randomized
- Blindingblinding unclear
- Control group+15/15
- Sample size (n=124)+9.2/20
- Follow-up+10/10
100 / 100
77 / 100
- P-values+15/15
- Effect size+20/20
- Confidence intervals+15/15
- 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 562 / 100
Probability of being correct
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
This design cannot establish causation — the findings describe an association, not a cause. This is a retrospective cohort study without randomization. Differences between groups (e.g., inclusion of Gleason 3+4 in T group, different biopsy protocols) introduce potential confounding and selection bias. Causal relationships cannot be established; only associations can be observed.
No Conflicts
No conflicts of interest identified
No conflicts identified.
No conflict of interest or funding information provided in the text.