This report presents our experience with T therapy in a cohort of T‑deficient men on active surveillance (AS) for Gleason 3 + 3 and
Gleason 3 + 4 prostate cancer (PCa). A retrospective chart review identified 28 men with T deficiency who underwent T therapy (T group)
for at least 6 months while on AS for PCa. A comparison group of 96 men on AS for PCa with untreated T deficiency (no‑T group) was
identified at the same institution. The AS protocol followed a modified Epstein criteria and allowed inclusion of men with a single core of low‑volume Gleason 3 + 4 PCa. Mean age was 59.5 and 61.3 years, and mean follow‑up was 38.9 and 42.4 months for the T and no‑T
groups, respectively. Of all 28 men in the T group, 3 (10.7%) men developed an increase in Gleason score while on AS. Of 22 men in
the T group with Gleason 3 + 3 disease, 7 (31.8%) men developed biopsy progression including 3 men (13.6%) who developed Gleason
3 + 4 PCa. Of 6 men with Gleason 3 + 4 disease at baseline, 2 (33.3%) men developed an increase in tumor volume, and none developed
upgrading beyond Gleason 3 + 4. All 96 men in the no‑T group had Gleason 3 + 3 disease at baseline and, 43 (44.7%) developed biopsy
progression, including 9 men (9.38%) with upgrading to Gleason 7 (3 + 4). Biopsy progression rates were similar for both groups and
historical controls. Biopsy progression in men on AS appears unaffected by T therapy over 3 years. Prospective placebo‑controlled trials of T therapy in T‑deficient men on AS should be considered given the symptomatic benefits experienced by treated men.

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