Mikkel Bandak1, Niels Jørgensen2, Anders Juul2, Jakob Lauritsen3, Maria Gry Gundgaard Kier4, Mette Saksø Mortensen3, Gedske Daugaard3. 1. Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark. Electronic address: mikkel.bandak@regionh.dk. 2. Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Denmark. 3. Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark. 4. Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark; Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.
Abstract
BACKGROUND: Controversy exists whether Leydig cells recover after testicular cancer (TC) treatment or whether premature hormonal aging will occur. OBJECTIVE: Evaluate serial changes in total testosterone (TT) and luteinizing hormone (LH) in patients treated with orchiectomy alone (Stage I) or combination chemotherapy with bleomycin, etoposide, and cisplatin (BEP). DESIGN, SETTINGS, AND PARTICIPANTS: Changes in TT and LH were investigated during 5-yr follow-up (Stage I: n=75, BEP: n=81). A selected group of TC patients with mild Leydig cell dysfunction (LH ≥ 8 IU/l) were followed for a longer period (Stage I: n=20, BEP: n=23). An age-matched control group of 839 healthy men served as controls for TT and LH levels. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Changes in age-adjusted TT and LH were evaluated separately in each treatment group with univariate linear regression analysis. The proportion of patients initiating testosterone substitution during follow-up was calculated. RESULTS AND LIMITATIONS: In the 75 Stage I patients there were no significant changes in LH and TT, while in the 81 BEP treated patients there was a significant decline in LH during follow-up (-24.2 percentage point/yr, 95% confidence interval: -38.5 to -9.9, p=0.001). In total, 11% of Stage I patients and 15% of BEP-treated patients initiated testosterone substitution. In the 23 BEP-treated patients with mild Leydig cell dysfunction there was a significant decline in age-adjusted TT (-0.9 percentage point/yr, 95% confidence interval: -1.8 to -0.04, p=0.04), while in the 20 Stage I patients there were no significant changes in age-adjusted LH and TT. Limitations include the retrospective study design. CONCLUSIONS: TT remained stable during 5-yr follow-up in TC patients treated with orchiectomy alone or BEP. BEP-treated patients with mild Leydig cell dysfunction during follow-up were at risk of long-term testicular failure and evaluation of Leydig cell function beyond follow-up should be considered in this group of patients. PATIENT SUMMARY: This study shows that the majority of testicular cancer survivors had stable testosterone levels after treatment for testicular cancer. However, 11-15% of patients needed testosterone substitution after treatment.
BACKGROUND: Controversy exists whether Leydig cells recover after testicular cancer (TC) treatment or whether premature hormonal aging will occur. OBJECTIVE: Evaluate serial changes in total testosterone (TT) and luteinizing hormone (LH) in patients treated with orchiectomy alone (Stage I) or combination chemotherapy with bleomycin, etoposide, and cisplatin (BEP). DESIGN, SETTINGS, AND PARTICIPANTS: Changes in TT and LH were investigated during 5-yr follow-up (Stage I: n=75, BEP: n=81). A selected group of TC patients with mild Leydig cell dysfunction (LH ≥ 8 IU/l) were followed for a longer period (Stage I: n=20, BEP: n=23). An age-matched control group of 839 healthy men served as controls for TT and LH levels. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Changes in age-adjusted TT and LH were evaluated separately in each treatment group with univariate linear regression analysis. The proportion of patients initiating testosterone substitution during follow-up was calculated. RESULTS AND LIMITATIONS: In the 75 Stage I patients there were no significant changes in LH and TT, while in the 81 BEP treated patients there was a significant decline in LH during follow-up (-24.2 percentage point/yr, 95% confidence interval: -38.5 to -9.9, p=0.001). In total, 11% of Stage I patients and 15% of BEP-treated patients initiated testosterone substitution. In the 23 BEP-treated patients with mild Leydig cell dysfunction there was a significant decline in age-adjusted TT (-0.9 percentage point/yr, 95% confidence interval: -1.8 to -0.04, p=0.04), while in the 20 Stage I patients there were no significant changes in age-adjusted LH and TT. Limitations include the retrospective study design. CONCLUSIONS:TT remained stable during 5-yr follow-up in TC patients treated with orchiectomy alone or BEP. BEP-treated patients with mild Leydig cell dysfunction during follow-up were at risk of long-term testicular failure and evaluation of Leydig cell function beyond follow-up should be considered in this group of patients. PATIENT SUMMARY: This study shows that the majority of testicular cancer survivors had stable testosterone levels after treatment for testicular cancer. However, 11-15% of patients needed testosterone substitution after treatment.
Authors: Wassim Chemaitilly; Qi Liu; Laura van Iersel; Kirsten K Ness; Zhenghong Li; Carmen L Wilson; Tara M Brinkman; James L Klosky; Nicole Barnes; Karen L Clark; Rebecca M Howell; Susan A Smith; Matthew J Krasin; Monika L Metzger; Gregory T Armstrong; Michael W Bishop; Hanneke M van Santen; Ching-Hon Pui; Deo Kumar Srivastava; Yutaka Yasui; Melissa M Hudson; Leslie L Robison; Daniel M Green; Charles A Sklar Journal: J Clin Oncol Date: 2019-09-26 Impact factor: 44.544
Authors: Cecilie R Buskbjerg; Robert Zachariae; Mads Agerbæk; Claus H Gravholt; Lene Haldbo-Classen; S M Hadi Hosseini; Ali Amidi Journal: Brain Imaging Behav Date: 2021-08-15 Impact factor: 3.978