Sperling Prostate Center

Are You on Active Surveillance but Have Low Testosterone? Here’s Good News

Manly. Virile. Macho. Hunky. Stud. How does man come to merit such terms? It’s due to his male hormones. When produced by special glands or organs, they are released into the bloodstream in order to “instruct” the development and function of male features. They help create and regulate a man’s masculine attributes, the physical and energy characteristics that make him manly.

The most well-known male hormone is testosterone. It affects not only a guy’s physique and fertility, but also his mood and mental state. Low testosterone (Low T) can take the fun and well-being out of his life: reduced sex drive and erectile function, loss of muscle and bone mass, poor sleep, depression, emotional instability, and increased cardiovascular risks are symptoms of a drop in T levels.

Testosterone replacement therapy (TRT)

There are several reasons why low T can occur. The most common is aging. It’s normal for T levels to slowly start to drop during or after midlife. However, other conditions can lessen T: certain chronic diseases; medical treatments; dysfunction of the hypothalamus, pituitary or thyroid gland; and injury to the testicles. Fortunately, a treatment method called testosterone replacement therapy (TRT) is safe for men who are clinically diagnosed with low T, and it works!

NOTE: Many other things can cause symptoms like loss of desire, erectile dysfunction, depression, mood swings, etc. Do not self-diagnose! A simple blood test will show if low T is the cause or not, so don’t rush to buy advertised products. See your doctor ASAP if you are concerned.

TRT and prostate cancer

Current research has established that TRT does not cause prostate cancer to begin, or to worsen low risk disease. I have previously written about the shifting professional views on TRT and prostate cancer. Thankfully, it is now widely accepted that patients who have gone through treatment, and who also have low T, can safely be prescribed TRT while being monitored for cancer recurrence.

TRT and Active Surveillance

What about patients who have been diagnosed with low-risk disease but are on Active Surveillance (AS)? The benefits of AS are increasingly being discussed with newly diagnosed patients as a way to avoid the side effect risks of whole gland treatment, for as long as possible. A July 2023 study asks, “Does testosterone replacement therapy increase the risk of conversion to treatment in patients with
prostate cancer on active surveillance?”[i] To find out, for five years the authors followed two groups of PCa patients who were on AS. Twenty-four of the AS patients were receiving TRT, while 72 were not. The percentage of those who came off AS to receive active treatment was the same in both groups.
Therefore, the researchers concluded, “TRT was not associated with conversion to treatment in this matched analysis among patients with localized prostate cancer on AS.”

This is good news for PCa patients with low T who are on AS. If and when they decide to move ahead with treatment, they can continue TRT. One final thought: before choosing which treatment to have, patients on AS should consider multiparametric MRI (mpMRI) on a 3T magnet. This revealing scan is the perfect aid for treatment planning, including determining if the patient is a candidate for focal treatment. When appropriately matched with an MRI-guided approach such as
Focal Laser Ablation
Exablate MRI guided Focused Ultrasound

It is a great middle ground between AS and whole gland treatment. As a happy medium, focal treatment offers competitive cancer control, yet minimal-to-no side effect risks. And, TRT can safely be continued during and after treatment.

The Sperling Prostate Center provides excellence in MRI detection, diagnosis, and treatment guidance for prostate cancer patients. Contact us for more information.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Daza J, Ahmad A, Shabir U, Jing Z et al. Does testosterone replacement therapy increase the risk of conversion to treatment in patients with prostate cancer on active surveillance? Urol Oncol. 2023 Jul 7:S1078-1439(23)00215-6.


About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

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