Testosterone monitoring and supplementation in patients with intermediate- or high-risk prostate cancer treated with 6-36 months of androgen deprivation therapy and radiotherapy: a systematic literature review.

Authors

Vérane Achard, Almuneda Zapatero, Amar U Kishan, Pierre Blanchard, Lisa G Horvath, Barbara A Jereczek-Fossa, Bertrand Tombal

Published in

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. Pages 111777. Sep 12, 2026. Epub Sep 12, 2026.

Abstract

Androgen deprivation therapy (ADT) combined with curative-intent radiotherapy is a cornerstone for intermediate- and high-risk localised prostate cancer, yet the clinical relevance of testosterone (T) monitoring and the safety of testosterone replacement therapy (TRT) in patients with persistent symptoms of hypogonadism remain uncertain. This systematic review synthesised evidence addressing four key questions: the prognostic role of baseline T, the impact of on-treatment T levels, the kinetics and determinants of T recovery after ADT, and the oncologic safety of TRT following curative treatment. Following PRISMA 2020 guidelines, major databases and conference proceedings were searched through May 2026 using Perplexity Computer (Anthropic Sonnet 4.6 / GPT-5 family models) under the direct supervision of the principal investigators. Twenty-nine studies were included. Baseline T was not associated with oncological outcomes but was a strong predictor of T recovery after treatment. On-treatment T suppression to < 20 ng/dL (<0.7 nmol/L), rather than the conventional 50 ng/dL (<1.7 nmol/L) threshold, was associated with improved oncologic outcomes. Recovery of T after ADT was heterogeneous and dependent on ADT duration. Non-castrate levels were typically achieved within 6-15 months, but full eugonadal recovery often required years and was incomplete in a substantial proportion of patients. In addition, older age, lower baseline T, and GnRH agonist use delayed recovery, whereas oral GnRH antagonists enabled faster normalisation. Very limited observational data suggest that TRT after curative treatment does not increase recurrence risk, although evidence in high-risk patients treated with ADT and radiotherapy is sparse. These findings support routine on-treatment T monitoring and highlight the need for prospective evaluation of TRT in this setting.

PMID:
42731757
Bibliographic data and abstract were imported from PubMed on 13 Sep 2026.

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