How to cite: Bernie HL. Testosterone and Prostate Cancer: From Dogma to Data. Grand Rounds in Urology. February 2026. Accessed Oct 2026. https://grandroundsinurology.com/testosterone-and-prostate-cancer-from-dogma-to-data/
Summary
Helen L. Bernie, DO, MPH, Director, Sexual and Reproductive Medicine and Assistant Professor of Urology, Indiana University, Carmel, Indiana, presents a review of the relationship between testosterone therapy and prostate cancer, focusing on the transition from historical dogma to contemporary data. Dr. Bernie explains that the longstanding concern that testosterone promotes prostate cancer progression originates from a 1941 study with limited data, including conclusions based on a single patient treated for a short duration.
Dr. Bernie reviews current guideline perspectives, noting that available guidance does not establish a clear link between testosterone therapy and the development of prostate cancer. She highlights that prostate-specific antigen (PSA) is an androgen-dependent marker and explains that low testosterone levels may be associated with more advanced disease at diagnosis.
Dr. Bernie summarizes observational and retrospective data evaluating testosterone therapy in men after radical prostatectomy and in those on active surveillance. These studies demonstrate no increase in biochemical recurrence, disease progression, or mortality associated with testosterone therapy. She also reviews findings from a large randomized trial evaluating testosterone therapy in hypogonadal men, which shows no significant increase in prostate cancer incidence or adverse prostate-related outcomes compared with placebo.
Dr. Bernie outlines a practical approach to testosterone therapy in men with prostate cancer, including comprehensive baseline evaluation, assessment of risk factors, and laboratory testing. She emphasizes the importance of patient counseling on risks and benefits, and on the absence of long-term safety data.
Dr. Bernie describes treatment initiation based on disease status and timing after therapy and recommends close monitoring with serial laboratory testing, including PSA. She argues that testosterone therapy may be considered in appropriately selected patients with careful monitoring and shared decision-making.
About the 45th Annual Ralph E. Hopkins Urology Seminar
The Annual Ralph E. Hopkins Urology Seminar, also known as the Jackson Hole Seminars, brings together distinguished urologists, clinical researchers, and thought leaders to share wisdom and experience that drives meaningful progress in patient care. Changes occur in medicine and urology on an almost daily basis, so it is imperative that the practicing urologist remains on the cutting edge. Urologists need to keep current on assessing, diagnosing, and treating urologic conditions in the clinical setting. The 45th meeting took place in 2026, focusing on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. 2026 also marked the meeting’s first-ever all-female speaker panel.
ABOUT THE AUTHOR
Helen L. Bernie, DO, MPH, is the Director of Sexual and Reproductive Medicine, and Assistant Professor of Urology at Indiana University, Carmel, Indiana. Working in men’s health, Dr. Bernie’s practice includes treatments for erectile dysfunction, infertility, Peyronie’s disease, testosterone therapy, cancer survivorship, and more.
