Testosterone replacement therapy following definitive treatment for prostate cancer: a scoping review of safety and efficacy

Testosterone replacement therapy (TRT) remains controversial in men with a history of prostate cancer due to historical concerns regarding oncologic safety. This scoping review aimed to systematically map existing evidence on the safety and efficacy of TRT in men following definitive treatment for prostate cancer. A systematic search of PubMed, CENTRAL, and Embase identified 447 records, from which 12 studies met inclusion criteria. Most were retrospective cohort studies, with sample sizes ranging from 10 to 152 men. TRT was not associated with an increased risk of biochemical recurrence or cancer progression in any included study. Reported PSA kinetics remained within expected post-treatment parameters, and several studies showed lower recurrence rates in TRT groups compared to controls. TRT consistently increased total and/or free testosterone and improved hypogonadal symptoms. However, the evidence base is limited by retrospective designs, small sample sizes, heterogeneous outcome reporting, and a lack of long-term data. Despite these limitations, findings suggest TRT may be cautiously considered in selected men with stable disease and confirmed hypogonadism. High-quality prospective studies are needed to clarify safety in diverse and high-risk populations and inform future clinical guidelines.