Table 1 Summary of Study Characteristics and Oncological Outcomes.

Pastuszak et al. [24]

Retrospective cohort study

98

External beam radiation therapy (EBRT), brachytherapy, or both; 51% also received ADT

Median 28.6 months (range 13.8–40.4)

Median 40.8 (range 1.5–147)

BCR rate 6.1%; PSA increased overall; significant in high-risk group (Gleason ≥8) only (0.10 to 0.36 ng/ml, p = 0.018); Median PSAV in all patients was −0.0002 ng/ml/yr; No difference in PSAV among risk groups (p = 0.074).

1) PSA > nadir + 2 ng/ml; 2) PSA > current nadir + 3 ng/ml; 3) 2 consecutive PSA rises ≥ 0.5 ng/ml

Ahlering et al. [18]

Retrospective, frequency-matched case-control study

152

Robot-assisted radical prostatectomy (RARP)

Not specified precisely; TRT initiated post-op in men with low cFT and delayed recovery

Median 40.8 months

TRT group had lower BCR (7.2%) compared to controls (12.6%) (p = 0.07); TRT associated with 54% reduced risk of BCR (p < 0.0001); delay in recurrence time by 1.5 years.

Two consecutive PSA values ≥ 0.2 ng/mL

Pastuszak et al. [20]

Retrospective cohort study with reference group (49 non-hypogonadal men treated with prostatectomy)

103

Radical prostatectomy (RP)

Median 12.3 months (IQR 7.8–16.8)

Median 27.5 (range 6.2–189.3)

4 TRT vs 8 controls had BCR (all in high risk groups); PSA increased from 0.004 ng/mL to 0.007 (p < 0.0001) in TRT group; PSAV in Treatment group was 0.002 ng/mL/yr ; PSAV low in TRT group, not indicative of recurrence.

Consecutive increasing PSAs and referral for salvage RT; AUA definition (PSA > 0.2 ng/ml) also applied

Khera et al. [27]

Retrospective cohort review

57

Radical prostatectomy (RP)

Mean 36 months (range 1–136)

Mean 13 (range 1–99)

No BCR or PSA increase observed; consistent across all Gleason score subgroups.

Any detectable rise in PSA after TRT

Agarwal & Oefelein, 2005 [28]

Retrospective cohort study

10

Radical retropubic prostatectomy (RRP)

Not explicitly stated

Median 19 (range not specified)

No BCR observed during follow-up; PSA remained undetectable (>0.1 ng/mL); mean T increased from 197 to 591 ng/dL; EPIC (Expanded Prostate Inventory Composite) scores improved; no oncologic progression noted.

PSA > 0.1 ng/mL considered detectable (used as recurrence marker)

Sarosdy, 2007 [30]

Retrospective case series

31

Permanent transperineal brachytherapy ( ± external beam radiotherapy); some received transient ADT

Median 24 months (range 6–54 months) post-brachytherapy

Median 60 months (range 18–108 months)

No BCR or PSA progression; PSA < 0.1 ng/mL in 74% and <0.5 ng/mL in 97% of patients; one transient PSA rise resolved by pausing TRT.

PSA progression; criteria not precisely defined but no confirmed recurrence observed

Shahine et al. [21]

Retrospective cohort study with matched control group

47

Robot-assisted radical prostatectomy (RARP)

Median 27 months (range 15–45.75)

Median 48 months (range 31.5–72)

BCR in 3/47 (6.4%) TRT group vs 157/1256 (12.6%) non-TRT group; multivariate analysis showed no association between TRT and BCR (p = 0.389).

PSA > 0.1 ng/mL

Balbontin et al. [29]

Prospective case series

20

Permanent low-dose-rate brachytherapy

Mean 14 months (range 3–36)

Median 31 months (range 12–48)

No BCR or PSA progression; one patient had a PSA bounce.

Phoenix definition (nadir + 2 ng/mL); PSA bounce defined as ≥0.2 ng/mL greater than nadir and subsequent return to nadir leves during the first 24 months.

Pastuszak et al. [22]

Retrospective cohort study

13

Brachytherapy (3 patients) or external beam radiotherapy (10 patients), 4 also received ADT

Median 13.5 months (range 2.6–170.9)

Median 29.7 months (range 2.3–67.3)

No confirmed BCR using Phoenix definition; one suspected recurrence ruled out; PSA increased but within expected parameters (baseline 0.3 ng/mL to 0.44 ng/mL at 12 months).

Phoenix definition, but no recurrence by nadir + 2 ng/mL or two PSA rises ≥ 0.5 ng/mL

Aglan et al. [25]

Retrospective single-center review

21

Androgen deprivation therapy (ADT) + External Beam Radiation Therapy (ERBT)

Median 19 from RT (IQR 12–44)

Median 15 months (IQR 9–48)

No BCR or clinical recurrence; mean PSA rose from 0.086 to 0.193 ng/dL (p = 0.008); one PSA bounce resolved after TRT discontinuation.

Not explicitly defined

Ory et al. [17]

Retrospective cohort study

72 (10 not treated with radical treatment therefore excluded from data extraction)

22 RP (6 also received ADT), 50 RT (37 EBRT, 13 brachytherapy) (14 also received ADT); (Excluded from data collection: 8 AS, 1 HIFU, 1 cryotherapy)

RP median of 15 months, RT median of 45 months.

RP median of 48 months, RP median of 36.5 months

No BCR in RP group; 3/50 (6%) BCR in RT group; Final median PSA in RP group undectable; Final median PSA in RT group 0.18 ng/mL (Initial median PSA 0.185 ng/mL); Median PSAV in RP group 0 ng/mL/yr; Median PSAV in RT group 0.0175 ng/mL/yr.

RP: AUA (PSA > 0.2 µg/L x2); RT: Phoenix (nadir + 2 µg/L)

Flores et al. [19]

Retrospective cohort study

101 (97 treated with clomiphene excluded from data extraction)

Radical prostatectomy for organ-confined PCa (GGG 1–3)

Earliest 3 months post-op; exact breakdown for TRT patients not given; median not specified

Median 35 months

No increase in BCR with TRT (HR 0.84; 95% CI 0.48–1.46; p = 0.5); 5-year BCR < 2% in both TRT and non-TRT groups; No seperation of BCR rates for TRT-only subgroup, but absence of elevated risk supports oncological safety.

PSA ≥ 0.1 ng/mL post-RP confirmed by a second PSA ≥ 0.1 ng/mL