Endocrine Abstracts

Introduction: Testosterone Replacement Therapy (TRT) is used for aged-related or other forms of hypogonadism and prostatic specific antigen (PSA) is primary screening tool for prostatic cancer in men. The European Academy of Andrology guidelines on investigation, treatment and monitoring of functional hypogonadism in males (EAA-TRT) endorsed by European Society of Endocrinology (ESE) states Recommendation #31. We suggest performing digital rectal examination and checking PSA at 3 to 12 months for men >40 years of age after initiating T treatment. After the first 12 months, local guidelines for prostate cancer screening for the general population should be followed. Recommendation #32. We suggest further evaluation and/or urological consultation if there is: (a) an increase in serum PSA concentration > 1.4 ng/ml within 12 months of initiating T treatment, (b) a confirmed PSA > 4 ng/ml at any time and (c) detection of a prostatic abnormality on DRE or a substantial worsening of LUTS. Currently we have a local follow up arrangement, namely PSA at TRT initiation with annual check and further urological assessment if PSA increase if beyond age-adjusted limit. We would like to apply retrospectively the above-mentioned (EAA-TRT) PSA monitoring schedule and determine the outcome in patients who have received intramuscular TRT for first 5 years period of therapy.

Description of Methods/Design: We retrospectively analysed PSA and reviewed outcome in patients receiving intramuscular TRT every 10-14 weeks with 5 years follow up.

Results: n=22. Age 52 (41-73) years and PSA at TRT initiation 0.89 (0.09-5.06) µg/l (median and range). 21/22 (95%) patients had no PSA increase >1.4 µg/l after one year of therapy. Among these, one patient (aged 61) identified as having raised PSA at TRT initiation and subsequently confirmed benign prostatic hypertrophy with stable PSA. Only one (aged 73) with PSA rise >1.4 µg/l after one year and found to have prostatic carcinoma and treated. There is no correlation between PSA and age at TRT initiation, Spearman coefficient ρ=0.13.

Conclusion: Using the EAA-TRT PSA monitoring schedule, we would have identified same individuals at risk of prostatic pathology who warrant urological investigations and some individuals would not need further PSA monitoring beyond one year. However, the majority would still need PSA testing anyway because of increased risk of prostatic cancer based on their age (>50) and ethnicity (up to 15% of Black and Afro-Caribbean origins) and who would normally be included in the PSA testing programme.