Gonadal Hormones in Long-Term Survivors 10 Years after Treatment for Unilateral Testicular Cancer

Nord, Carina; Bjøro, Trine; Ellingsen, Dag G.; Mykletun, Arnstein; Dahl, Olav; Klepp, Olbjørn; Bremnes, Roy M.; Wist, Erik; Fosså, Sophie D.

doi:10.1016/s0302-2838(03)00263-x

Cited by 173 publications

(118 citation statements)

References 31 publications

Supporting

Mentioning

109

Contrasting

Unclassified

Order By: Relevance

“…This phenomenon is similar to that recently reported for sperm production, with a significant decline in sperm concentration after 6-12 months and after subsequent recovery to the pretreatment level (15). The time-related post-treatment recovery of Leydig cell function is in discordance with the data published by Nord et al who reported an increased risk of hypogonadism 10 years after completion of TGCC treatment (11). However, the longer observation time and therefore an age-dependent deterioration cannot be excluded in the latter study.…”

Section: Discussionsupporting

confidence: 89%

“…In a 10-year follow-up study, Nord et al found that men treated for TGCC had a three-to fourfold risk to develop hypogonadism and that the risk increased with age and treatment intensity (11,12). Another study reported increased risk of gonadal dysfunction in long-term survivors of testicular cancer and there was a dose-response effect following chemotherapy (12).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors for post-treatment hypogonadism in testicular cancer patients.

Eberhard

Ståhl

Cwikiel

et al. 2008

European Journal of Endocrinology

View full text Add to dashboard Cite

Objectives: 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 O10 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,, 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.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Risk factors for post-treatment hypogonadism in testicular cancer patients.

Eberhard

Ståhl

Cwikiel

et al. 2008

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…A recent large Norwegian study found similar abnormalities in LH, which were significantly elevated compared to normal controls even in those treated by orchidectomy alone (Nord et al, 2003).…”

Section: Discussionmentioning

confidence: 72%

Fertility, gonadal and sexual function in survivors of testicular cancer

et al. 2005

View full text Add to dashboard Cite

Modern treatments cure most testicular cancer patients, so an important goal is to minimise toxicity. Fertility and sexual functioning are key issues for patients. We have evaluated these outcomes in a cross-sectional study of long-term survivors of testicular cancer. In total, 680 patients treated between 1982 and 1992 completed the EORTC Qly-C-30(qc30) questionnaire, the associated testicular cancer specific module and a general health and fertility questionnaire. Patients have been subdivided according to treatment received: orchidectomy either alone (surveillance, S n ¼ 169), with chemotherapy (C, n ¼ 272), radiotherapy (R, n ¼ 158), or both chemotherapy and radiotherapy (C/RT n ¼ 81). In the surveillance group, 6% of patients had an elevated LH, 41% an elevated FSH and 11% a low (o10 nmol l À1 ) testosterone. Hormonal function deteriorated with additional treatment, but the effect in general was small. Low testosterone was more common in the C/RT group (37% P ¼ 0.006), FSH abnormalities were more common after chemotherapy (C 49%, C/RT 71% both Po0.005) and LH abnormalities after radiotherapy (11% Po0.01) and chemotherapy (10%, Po0.001). Baseline hormone data were available for 367 patients. After treatment, compared to baseline, patients receiving chemotherapy had significantly greater elevations of FSH (median rise of 6 (IQR 3 -9.25) iu l À1 compared to 3 (IQR 1 -5) iu l À1 for S; Po0.001) and a fall (compared to a rise in the surveillance group) in median testosterone levels (À2 (IQR À8.0 to À1.5) vs 1.0. (IQR À4.0 -4.0) Po0.001). Patients with low testosterone (but not elevated FSH) had lower quality of life scores related to sexual functioning on the testicular cancer specific module and lower physical, social and role functioning on the EORTC Qly C-30. Patients with a low testosterone also had higher body mass index and blood pressure. Treatment was associated with reduction in sexual activity and patients receiving chemotherapy had more concerns about fathering children. In total, 207 (30%) patients reported attempting conception of whom 159 (77%) were successful and a further 10 patients were successful after infertility treatment with an overall success rate of 82%. There was a lower overall success rate after chemotherapy (C 71%; CRT 67% compared to S 85% (P ¼ 0.028)). Elevated FSH levels were associated with reduced fertility (normal FSH 91% vs elevated 68% Po0.001). In summary, gonadal dysfunction is common in patients with a history of testicular cancer even when managed by orchidectomy alone. Treatment with chemotherapy in particular can result in additional impairment. Gonadal dysfunction reduces quality of life and has an adverse effect on patient health. Most patients retain their fertility, but the risk of infertility is likely to be increased by chemotherapy. Screening for gonadal dysfunction should be considered in the follow-up of testicular cancer survivors. Testicular cancer is the most common cancer of young men in their 20s and 30s. Since the advent of effective multiagent cisplatinu...

show abstract

“…This difference may also be due to differences in the pre-treatment gonadal function between HLSs and NHLSs, pointed out by Botchan et al (1997). Increasing risk of endocrine hypogonadism along with chemotherapy intensification has also been documented for testicular cancer survivors (Nord et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Gonadal function in male patients after treatment for malignant lymphomas, with emphasis on chemotherapy

Kiserud¹,

Fosså

Bjøro

et al. 2009

Br J Cancer

View full text Add to dashboard Cite

Gonadal function was assessed in male lymphoma survivors based on serum hormone levels (LH, FSH, testosterone, SHBG), and was related to treatment, age and observation time. Male patients ⩽50 years at diagnosis treated for Hodgkin's (HL) and/or non-Hodgkin's lymphoma (NHL) at the Norwegian Radium Hospital from 1 January 1980 to 31 December 2002 were included. Five treatment groups were defined: 1: radiotherapy only and/or low gonadotoxic chemotherapy (both HL and NHL)(‘No/low'), 2: medium gonadotoxicity chemotherapy for NHL (‘med-NHL'), 3: medium gonadotoxicity chemotherapy for HL (‘med-HL'), 4: highly gonadotoxic chemotherapy for NHL (‘high-NHL'), 5: highly gonadotoxic chemotherapy for HL (‘high-HL'). Gonadal hormone levels were categorised into three groups: 1: All gonadal hormones within normal range (normal), 2: Isolated elevated FSH, with LH, SHBG and testosterone within normal range (exocrine hypogonadism), 3: Testosterone below and/or LH above normal range (endocrine hypogonadism). One hundred and forty-four (49%) of the patients had normal gonadal hormones, 60 (20%) displayed exocrine hypogonadism and almost one-third ( n =90, 30%) had endocrine hypogonadism. Compared to those treated with no/low gonadotoxic chemotherapy patients from all other treatment groups had significantly elevated risk for exocrine hypogonadism. Patients from the other treatment groups, except those in the med-NHL group, also had significantly elevated risk for endocrine hypogonadism compared with the group treated with no/low gonadotoxic chemotherapy. Men aged above 50 years at survey were about five times more likely to have endocrine hypogonadism compared with those less than 40 years. Because of the adverse health effects following long-lasting endocrine hypogonadism, gonadal hormones should be assessed regularly in male lymphoma survivors, especially after treatment with alkylating agents and high-dose chemotherapy with autologous stem cell support and in male patients who are 50 years and older.

show abstract

Gonadal Hormones in Long-Term Survivors 10 Years after Treatment for Unilateral Testicular Cancer

Cited by 173 publications

References 31 publications

Risk factors for post-treatment hypogonadism in testicular cancer patients.

Risk factors for post-treatment hypogonadism in testicular cancer patients.

Fertility, gonadal and sexual function in survivors of testicular cancer

Gonadal function in male patients after treatment for malignant lymphomas, with emphasis on chemotherapy

Contact Info

Product

Resources

About