Clinically occult prostate cancer cases may distort the effect of testosterone replacement therapy on risk of PCa.
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BACKGROUND: Although prostate cancer (PCa) screening is conducted before testosterone replacement therapy (TRT), clinically occult PCa cases may exist. METHODS: To evaluate whether the possible inclusion of occult PCa cases distorts the effect of TRT on risk of PCa, we followed 776 hypogonadal males (TRT=400, non-TRT=376) from a urology center in Germany from 2004 to 2016, with a mean follow-up period of 7years. We assumed occult cases might take 1-2years (latency period) to become clinically detectable after receiving TRT. We selected several latency periods (12/18/24months) and compared the risk of PCa in the TRT and non-TRT group over the latency period, from the end of latency period till the end of follow-up, and over the whole follow-up time. RESULTS: Overall, 26 PCa cases occurred in the non-TRT group vs 9 cases in the TRT group. Within 18months of follow-up, 9 cases occurred in the TRT group vs 0 cases in the non-TRT group; from the end of 18months till the end of follow-up, 26 cases occurred in the non-TRT group vs 0 cases in the TRT group. The adjusted table showed seemingly adverse effects of TRT on PCa development within 18months (p=0.0301) and beneficial effects from the end of 18months till the end of follow-up (p=0.0069). Similar patterns were observed for 12 or 24months as the latency period. CONCLUSIONS: TRT may make occult PCa cases detectable within early phase of treatment and present a beneficial effect in the long run. Future longitudinal studies are needed to confirm findings from our exploratory analyses.