Hormonal
Testosterone replacement therapy in older men with hypogonadism causes a modest, predictable increase in serum PSA levels (average ~0.3-0.5 ng/mL) but does not appear to increase the incidence of clinically overt prostate cancer in existing short-to-medium term randomized controlled trials.
If you are an older man with clinically low testosterone, TRT will likely raise your PSA levels slightly (by about 0.3-0.5 ng/mL). This is a normal physiological response, not a sign of cancer. Current studies do not show that TRT increases the risk of developing prostate cancer, although long-term data is still needed. You should undergo regular PSA monitoring; a rise of more than 1.4 ng/mL from your baseline warrants further urological evaluation, but small increases are expected.
These data taken together suggest that the administration of replacement doses of testosterone in men with androgen deficiency can be expected to produce a modest increment in serum PSA levels... In the long-term, randomized, placebo-controlled trials of testosterone supplementation in older men... the total number of prostate cancers has not been numerically greater in testosterone-treated men than in placebo-treated men.
Why this rating
Based on multiple RCTs but explicitly noted as underpowered to detect small increases in cancer incidence; requires large long-term trials.
Source
Managing the Risks of Prostate Disease During Testosterone Replacement Therapy in Older Men: Recommendations for a Standardized Monitoring Plan
Shalender Bhasin et al. · Journal of Andrology · 2003
DOI 10.1002/j.1939-4640.2003.tb02676.x
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