Gynecomastia in testicular cancer patients. Prognostic and therapeutic implications.
Eighty-one patients with advanced testicular cancer were evaluated for gynecomastia or severe breast tenderness at diagnosis and after platinum-based chemotherapy. The prognostic significance of gynecomastia in these two settings was explored. At presentation, 10% (8 patients) had gynecomastia or breast tenderness and elevated HCG levels. The likelihood of gynecomastia was greater with increasing HCG level (P = 0.002). However, gynecomastia at presentation was a more powerful independent discriminant of poor survival than the initial HCG level by multivariate analysis (P = 0.004). Fifteen percent (12 patients) developed transient gynecomastia after chemotherapy not attributable to other known causes. HCG levels were normal. Endocrine evaluation typically revealed elevated FSH, LH, and estradiol/testosterone ratios. This may have reflected damage to testicular germinal epithelium. All 12 patients are alive without disease in contrast to the 8 patients who had gynecomastia at diagnosis. Therapy decisions should therefore be based on the time of onset of gynecomastia and in the context of appropriate clinical markers and evaluation.
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001940:Breast / Q000473:pathology*; D002369:Castration; D006063:Chorionic Gonadotropin / Q000097:blood; D004407:Dysgerminoma / Q000473:pathology; D005500:Follow-Up Studies; D006177:Gynecomastia / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010808:Physical Examination; D011379:Prognosis; D013724:Teratoma / Q000473:pathology; D013736:Testicular Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology*; D013997:Time Factors
D006063:Chorionic Gonadotropin