Risk factors for post-treatment hypogonadism in testicular cancer patients.
OBJECTIVE
Testicular germ-cell cancer (TGCC) patients are at risk of developing hypogonadism but no risk factors have yet been defined.


METHODS
Blood was collected from 143 TGCC patients (after orchidectomy, prior to further therapy (T0) and 6, 12, 24, 36 and 60 months (T6, T12, T24, T36 and T60) after therapy). Biological hypogonadism (BH) was defined as: serum testosterone below 10 nmol/l and/or LH >10 IU/l; odds ratios (ORs) for BH with BH at T0, age, stage of disease, testicular characteristics, and androgen receptor polymorphism as predictors were calculated as well as the OR for developing BH post-treatment (one to two cycles of adjuvant chemotherapy (ACT) versus three to four cycles of higher dose chemotherapy (HCT) versus adjuvant radiotherapy (RT)).


RESULTS
HCT increased the OR for BH at T6 (OR 22, 95% confidence interval (CI) 4.4-118) and T12 (OR 5.8, 95% CI 1.5-22). RT increased the OR at T6 (OR 10, 95% CI 2.1-47) and at T12 (OR 3.9, 95% CI 1.1-14). Microlithiasis predicted BH at T0 (OR 11, 95% CI 1.2-112), T12 (OR 3.9, 95% CI 1.1-13), T24 (OR 3.0, 95% CI 1.0-8.8), T36 (OR 5.4, 95% CI 1.7-17) and T60 (OR 4.4, 95% CI 1.2-16). BH at T0 was a risk for BH at T6 (OR 53, 95% CI 19-145), T12 (OR 125, 95% CI 37-430), T24 (OR 88, 95% CI 26-300) and T36 (OR 121, 95% CI 32-460).


CONCLUSIONS
It is clinically relevant that BH at T0 and testicular microlithiasis were predictive factors for post-treatment BH. HCT and RT gave temporary BH.
Eberhard
Jakob
J
Department of Oncology, Lund University Hospital, Lund University, SE 22185 Lund, Sweden. jakob.eberhard@med.lu.se
Ståhl
Olof
O
Cwikiel
Magdalena
M
Cavallin-Ståhl
Eva
E
Giwercman
Yvonne
Y
Salmonson
Eva Cecilia
EC
Giwercman
Aleksander
A
D000328:Adult; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000009:adverse effects; D003561:Cytarabine / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000209:etiology*; D020347:Lithiasis / Q000150:complications; D008137:Longitudinal Studies; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000097:blood / Q000601:surgery*; D009919:Orchiectomy / Q000009:adverse effects; D011446:Prospective Studies; D011832:Radiation Injuries / Q000150:complications; D011878:Radiotherapy / Q000009:adverse effects; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012307:Risk Factors; D013733:Testicular Diseases / Q000150:complications; D013736:Testicular Neoplasms / Q000097:blood / Q000628:therapy*; D013739:Testosterone / Q000097:blood; D013866:Thioguanine / Q000009:adverse effects / Q000627:therapeutic use
D003561:Cytarabine; D013739:Testosterone; D004317:Doxorubicin; D013866:Thioguanine