title: Testosterone deficiency in testicular cancer survivors - a systematic review and meta-analysis.
abstract: Results concerning treatment of Testicular Germ Cell Cancer (TGCC) and subsequent risk of testosterone deficiency are conflicting. To systematically evaluate and estimate the risk of testosterone deficiency (TD) in TGCC-patients according to treatment to optimize follow-up and for prevention of late effects related to hypogonadism. We performed a critical review of PubMed in January 2015 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Twelve publications were selected for inclusion in this analysis. Eleven studies evaluated the risk of TD in TGCC-patients treated with standard chemotherapy (CT) and the odds ratio for TD was 1.8 (95% CI) (1.3-2.5), (p = 0.0007). Seven studies evaluated the risk of TD in TGCC-patients treated with non-conventional therapy and the odds ratio for TD was 3.1 (95% CI) (2.0-4.8), (p < 0.0001). Six studies evaluated the risk of TD in TGCC-patients treated with infradiaphragmatic radiotherapy (RT), and the odds ratio for TD was 1.6 (95% CI) (1.0-2.4), (p = 0.03). In all treatment groups the risk of TD was compared with TGCC-patients treated with orchiectomy alone. There was no indication of heterogeneity between studies in the three treatment groups. Strong evidence exists that standard CT, non-conventional therapy and infradiaphragmatic RT are associated with an increased risk of TD in TGCC-patients when compared with orchiectomy alone. The risk of testosterone defficiency appears to be highest in patients treated with non-conventional therapy.
authors.affiliation: Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Bandak
authors.affiliation: Department of Growth and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: N
authors.initials: N
authors.lastname: Jørgensen
authors.affiliation: Department of Growth and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Juul
authors.affiliation: Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: I R
authors.initials: IR
authors.lastname: Vogelius
authors.affiliation: Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Lauritsen
authors.affiliation: Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.|Department of Survivorship, Danish Cancer Society, Copenhagen, Denmark.
authors.forename: M G
authors.initials: MG
authors.lastname: Kier
authors.affiliation: Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: M S
authors.initials: MS
authors.lastname: Mortensen
authors.affiliation: Department of Breast Surgery and Reconstructive Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Glovinski
authors.affiliation: Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: G
authors.initials: G
authors.lastname: Daugaard
mesh_terms: D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000209:etiology*; D008297:Male; D009919:Orchiectomy / Q000009:adverse effects*; D017741:Survivors; D013736:Testicular Neoplasms / Q000097:blood / Q000150:complications*; D013739:Testosterone / Q000172:deficiency*
chemical_list: D013739:Testosterone
keywords: systematic review; testicular germ cell cancer; testosterone deficiency