Retrospective Concomitant Nonrandomized Comparison of Testosterone Replacement Therapy Versus No Treatment for Erectile Function Post Radical Prostatectomy

Abstract Introduction Recent studies have shown that testosterone replacement therapy (TRT) can be safely applied in men with low-risk prostate cancer. Objective To assess TRT versus no TRT 2-year potency outcomes in hypogonadal men aged ≥ 60. Methods Retrospective concomitant nonrandomized comparison of 70 hypogonadal men, aged 60 or older, were stratified by TRT post-RP. Baseline demographics, total testosterone (TT) calculated free testosterone (cFT), and comorbidities prior to RP were measured from October 2016 – October 2020. Sexual function was assessed via the International Index of Erectile Function (IIEF-5) pre-and post-surgery. Potency (evaluated at 3-, 9-, 15-, and 24-months post-RP) was defined as erections sufficient for penetration and satisfying, and/or erection fullness >75%, and/or a score of 5 on Q1 (IIEF-5; confidence). T-tests, chi-square, and regression analyses were performed. Results Potency at 2 years was 63.6% (TRT) versus 35.1% (No TRT; p=0.017). Regression analysis showed that TRT was a predictor of potency outcomes 2 years post-RP (OR: 3.33; 95% CI: 1.16-10.3; p=0.029) after adjusting for age and Gleason Grade Group. There were no statistically significant differences in baseline factors between the TRT-receiving and no-TRT groups. BCR rates between the two groups were 12.1% (TRT) versus 27.0% (no TRT; p=0.12) with a mean follow-up time of 40.2 ± 13.6 months. Kaplan Meier analysis demonstrated a trend toward a significant difference in time to BCR (p=0.078). Conclusions In hypogonadal men aged ≥ 60, TRT significantly improved potency outcomes 2-years post-RP. The risk of BCR overall in men receiving TRT was lower but not statistically significant. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Faysal A Yafi, MD – Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.