Longitudinal Changes in Serum Levels of Testosterone and Luteinizing Hormone in Testicular Cancer Patients after Orchiectomy Alone or Bleomycin, Etoposide, and Cisplatin

TY - JOUR

T1 - Longitudinal Changes in Serum Levels of Testosterone and Luteinizing Hormone in Testicular Cancer Patients after Orchiectomy Alone or Bleomycin, Etoposide, and Cisplatin

AU - Bandak, Mikkel

AU - Jørgensen, Niels

AU - Juul, Anders

AU - Lauritsen, Jakob

AU - Kier, Maria Gry Gundgaard

AU - Mortensen, Mette Saksø

AU - Daugaard, Gedske

PY - 2018/7

Y1 - 2018/7

N2 - 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. Testosterone levels were stable in the majority of testicular cancer patients; however, 11–15% developed primary testicular failure entailing testosterone substitution. Testosterone levels should be evaluated at regular intervals during the 1st yr after treatment for testicular cancer.

AB - 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. Testosterone levels were stable in the majority of testicular cancer patients; however, 11–15% developed primary testicular failure entailing testosterone substitution. Testosterone levels should be evaluated at regular intervals during the 1st yr after treatment for testicular cancer.

U2 - 10.1016/j.euf.2016.11.018

DO - 10.1016/j.euf.2016.11.018

M3 - Journal article

C2 - 28753832

SN - 2405-4569

VL - 4

SP - 591

EP - 598

JO - European Urology Focus

JF - European Urology Focus

IS - 4

ER -