Testosterone replacement therapy and bladder cancer

Abstract

Muscle-invasive bladder cancer is a common malignancy, and its standard of care treatment often involves neoadjuvant chemotherapy and radical cystectomy. These treatments are invasive and associated with significant mortality and morbidity. Neoadjuvant chemotherapy is associated with skeletal muscle atrophy and reduced body mass, while radical cystectomy is associated with high-risk blood loss necessitating blood transfusion. Despite an established relationship between androgens and prostate cancer, it is unclear whether androgens impact other types of cancer, including bladder cancer. In fact, decades of research on the relationship between anti-androgens and cancer prevention/treatment have provided conflicting or inconclusive results. Preoperative testosterone could prevent surgery-related skeletal muscle atrophy and help maintain normal hematocrit levels. Preoperative testosterone is an inexpensive and feasible intervention and seems to improve postoperative recovery with minimal adverse effects in different patient populations. To date, no clinical trial has been conducted evaluating preoperative testosterone in bladder cancer patients. In this review, we present a rationale for the use of preoperative testosterone in bladder cancer patients, which we believe may serve as the basis for the development of a future clinical trial.