{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:09:19Z","timestamp":1781669359910,"version":"3.54.5"},"reference-count":94,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To evaluate the oncological safety of testosterone replacement therapy (TRT) in hypogonadal patients with prostate cancer, as testosterone deficiency (TD) rises in prevalence with age and in prostate cancer may be treatment\u2010related, whilst contributing to poor health outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>Following Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses guidelines, Medline, EMBASE, PubMed, and Scopus were searched. Studies were included assessing progression and biochemical recurrence in men with prostate cancer and TD receiving TRT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Searches yielded 4067 studies, of which 19 were included: five in active surveillance, 10 post\u2010radical prostatectomy (RP), six post\u2010radiotherapy. Pooled meta\u2010analysis was not valid due to insufficient number of comparative studies and significant clinical and methodological heterogeneity. Progression rates on active surveillance ranged from 0% to 32% and did not differ significantly to non\u2010exposed controls on retrospective comparison at follow\u2010up as long as 70\u2009months. Biochemical recurrence rates in TRT\u2010exposed cohorts were low post\u2010definitive treatment ranging from 0% to 7% post\u2010RP to 0\u20136% post\u2010radiotherapy (\u00b1\u2009androgen deprivation therapy) with up to 60\u2009months of follow\u2010up. Overall certainty of TRT oncological safety is limited by lack of long\u2010term, prospective, controlled comparative data and lack of assessment of survival outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Retrospective evidence supports cautious use of TRT in low\u2013intermediate\u2010risk disease on active surveillance and favourable localised disease post\u2010RP or post\u2010radiotherapy with appropriate prostate\u2010specific antigen responses. Diligent patient selection and monitoring are required until randomised controlled trial data are available to inform safe management of TD in prostate cancer.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bju.16870","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T11:04:53Z","timestamp":1754046293000},"page":"788-799","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Oncological safety of testosterone replacement therapy in men with localised prostate cancer: a systematic review of observational studies"],"prefix":"10.1111","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4283-7215","authenticated-orcid":false,"given":"Jordan","family":"Santucci","sequence":"first","affiliation":[{"name":"Department of Urology Cabrini Health  Malvern Vic. Australia"},{"name":"Department of Urology Grampians Health  Ballarat Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8513-3711","authenticated-orcid":false,"given":"Peter","family":"Stapleton","sequence":"additional","affiliation":[{"name":"Department of Urology Lyell McEwin Hospital  Elizabeth Vale SA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1138-6389","authenticated-orcid":false,"given":"Marlon","family":"Perera","sequence":"additional","affiliation":[{"name":"Department of Urology Austin Health  Heidelberg Vic. Australia"},{"name":"Department of Genitourinary Oncology Peter MacCallum Cancer Centre  Parkville Vic. Australia"},{"name":"Department of Surgery University of Melbourne  Parkville Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Ischia","sequence":"additional","affiliation":[{"name":"Department of Urology Austin Health  Heidelberg Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7500-5899","authenticated-orcid":false,"given":"Declan","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Oncology Peter MacCallum Cancer Centre  Parkville Vic. Australia"},{"name":"The Sir Peter MacCallum Department of Oncology University of Melbourne  Parkville Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Bolton","sequence":"additional","affiliation":[{"name":"Department of Urology Austin Health  Heidelberg Vic. Australia"},{"name":"Department of Surgery University of Melbourne  Parkville Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8553-5618","authenticated-orcid":false,"given":"Nathan","family":"Lawrentschuk","sequence":"additional","affiliation":[{"name":"Department of Genitourinary Oncology Peter MacCallum Cancer Centre  Parkville Vic. Australia"},{"name":"Department of Surgery University of Melbourne  Parkville Vic. Australia"},{"name":"Department of Urology Royal Melbourne Hospital  Parkville Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Frydenberg","sequence":"additional","affiliation":[{"name":"Department of Urology Cabrini Health  Malvern Vic. Australia"},{"name":"Department of Surgery Monash University  Clayton Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3710-014X","authenticated-orcid":false,"given":"Niranjan","family":"Sathianathen","sequence":"additional","affiliation":[{"name":"Department of Urology Austin Health  Heidelberg Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v3.i4.338"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2018.03.115"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-4295(99)00172-7"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22676"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa074311"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000054462.88306.43"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2008.01159.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2005.05893.x"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2009-2354"},{"issue":"1","key":"e_1_2_8_11_1","first-page":"S26","article-title":"Testosterone therapy in men with prostate cancer: scientific and ethical considerations","volume":"189","author":"Morgentaler A","year":"2013","journal-title":"J Urol"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2008.00889.x"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1743-6109.2009.01161.x"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1756-8722-4-12"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2017.04.675"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/pros.1046"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2008.10.019"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2009.08428.x"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2008.10.047"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000154637.38262.3a"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1998.16.1.275"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/89.15.1117"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1159\/000176052"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199607043350101"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.82.2.407"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.2001.281.6.E1172"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-1184"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2015.10.083"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-15-0262"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2016-1645"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1506119"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-021058"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-032006"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.85.8.2839"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrc801"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)54531-0"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.22.4.232"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(196711)20:11<1871::AID-CNCR2820201112>3.0.CO;2-D"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2015.12.005"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2006.06.034"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2008.09.024"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/88.16.1118"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ucl.2007.08.007"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000091104.71869.8e"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djm323"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.4.847"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.13417"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2009.03.088"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2015.05.099"},{"key":"e_1_2_8_50_1","unstructured":"HigginsJPT LassersonT ThomasJ FlemyngE ChurchillR.Methodological expectations of Cochrane intervention reviews (MECIR): standards for the conduct of new Cochrane intervention reviews and the planning and conduct of updates [Internet]. Cochrane 2023. Available at:https:\/\/community.cochrane.org\/mecir\u2010manual. Accessed May 2025"},{"key":"e_1_2_8_51_1","volume-title":"The Newcastle\u2010Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta\u2010Analyses","author":"Wells GA","year":"2021"},{"key":"e_1_2_8_52_1","volume-title":"Quality Appraisal of Case Series Studies Checklist","author":"Institute of Health Economics (IHE)","year":"2014"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_8_54_1","unstructured":"HigginsJPT ThomasJ ChandlerJet\u00a0al.Cochrane Handbook for Systematic Reviews of Interventions [Internet]. Cochrane 2019 [updated 2024]. Available at:https:\/\/training.cochrane.org\/handbook\/current. Accessed May 2025"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2016.04.069"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2014.02.1477"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2017.11.220"},{"key":"e_1_2_8_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2015.05.084"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euros.2024.01.005"},{"key":"e_1_2_8_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2023.06.002"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.4103\/1008-682X.160270"},{"key":"e_1_2_8_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2023.05.008"},{"key":"e_1_2_8_63_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-020-03475-7"},{"key":"e_1_2_8_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15042"},{"key":"e_1_2_8_65_1","doi-asserted-by":"publisher","DOI":"10.1159\/000371725"},{"key":"e_1_2_8_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2013.02.002"},{"key":"e_1_2_8_67_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000143942.55896.64"},{"key":"e_1_2_8_68_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000136269.10161.32"},{"key":"e_1_2_8_69_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.12668"},{"key":"e_1_2_8_70_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijir.2012.29"},{"key":"e_1_2_8_71_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2008.07882.x"},{"key":"e_1_2_8_72_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22438"},{"key":"e_1_2_8_73_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.13206"},{"key":"e_1_2_8_74_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.12906"},{"key":"e_1_2_8_75_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2214122"},{"key":"e_1_2_8_76_1","unstructured":"SaloniaA MinhasS BoeriLet\u00a0al.Guidelines on Sexual and Reproductive Health: Male Hypogonadism [Internet]. European Association of Urology 2021 [updated 2025]. Available at:https:\/\/uroweb.org\/guidelines\/sexual\u2010and\u2010reproductive\u2010health\/chapter\/male\u2010hypogonadism. Accessed May 2025"},{"key":"e_1_2_8_77_1","doi-asserted-by":"publisher","DOI":"10.1159\/000481438"},{"key":"e_1_2_8_78_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.euo.2024.11.006"},{"key":"e_1_2_8_79_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2010.09.010"},{"key":"e_1_2_8_80_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.02759"},{"key":"e_1_2_8_81_1","doi-asserted-by":"publisher","DOI":"10.1002\/pros.21196"},{"key":"e_1_2_8_82_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30906-3"},{"key":"e_1_2_8_83_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-023-44514-2"},{"key":"e_1_2_8_84_1","doi-asserted-by":"publisher","DOI":"10.4103\/1008-682X.129132"},{"key":"e_1_2_8_85_1","doi-asserted-by":"publisher","DOI":"10.1111\/andr.13299"},{"key":"e_1_2_8_86_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2007.09.066"},{"key":"e_1_2_8_87_1","doi-asserted-by":"publisher","DOI":"10.1002\/pros.20341"},{"key":"e_1_2_8_88_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2006.06013.x"},{"key":"e_1_2_8_89_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2019.03.273"},{"key":"e_1_2_8_90_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(01)62383-8"},{"key":"e_1_2_8_91_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(97)82499-6"},{"key":"e_1_2_8_92_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(03)00538-8"},{"key":"e_1_2_8_93_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.281.17.1598"},{"key":"e_1_2_8_94_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(98)00091-1"},{"key":"e_1_2_8_95_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(18)31378-8"}],"container-title":["BJU International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bju.16870","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T19:37:08Z","timestamp":1760557028000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/10.1111\/bju.16870"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":94,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1111\/bju.16870"],"URL":"https:\/\/doi.org\/10.1111\/bju.16870","archive":["Portico"],"relation":{},"ISSN":["1464-4096","1464-410X"],"issn-type":[{"value":"1464-4096","type":"print"},{"value":"1464-410X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]},"assertion":[{"value":"2025-08-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}