Many Testicular Cancer Survivors May Have Undiagnosed Hypogonadism

CHICAGO-A new study is suggesting that a high percentage of testicular cancer survivors may suffer from hypogonadism (abstract LBA10012). Researchers at Indiana University reported at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 2–6, that 38% of 491 testicular cancer survivors were found to have hypogonadism. Compared with survivors with normal testosterone levels, survivors with hypogonadism were more likely to have a range of chronic health problems, including hypertension, diabetes, erectile dysfunction, and anxiety or depression.

“This is the first study of its size of North American testicular cancer survivors treated with chemotherapy,” said lead study author Mohammad Issam Abu Zaid, MBBS, an assistant professor of medicine at the Indiana University School of Medicine in Indianapolis.

He said that many survivors may live more than 5 decades beyond their diagnosis because testicular cancer occurs at a young age and is highly curable. Abu Zaid said these findings underscore the need for clinicians to assess testicular cancer survivors for physical signs or symptoms of hypogonadism and measure testosterone levels.

Low testosterone can be present at the time of a testicular cancer diagnosis, or it can develop as a side effect of surgery or chemotherapy. While it has been known that low testosterone occurs in a significant proportion of testicular cancer survivors, this is the first study of its kind to examine its relationship with long-term health complications in North American patients.

Abu Zaid presented the latest analysis on the first 491 patients enrolled in the Platinum study. All patients received chemotherapy, and the median age at clinical evaluation was 38 years (range, 19–68 years). Hypogonadism was defined as serum testosterone levels  ≤ 3.0 ng/mL or the need for testosterone replacement therapy.

Among the 491 survivors, 38% had a low testosterone level or were on testosterone replacement therapy. Being overweight or obese was associated with a higher chance of having low testosterone levels, as was older age. The researchers also found a genetic abnormality in the sex hormone–binding globulin gene that appears to predispose some men to low testosterone. “Genetic variants in the sex hormone–binding globulin gene appear important in the risk of hypogonadism; however, this finding needs to be confirmed in future studies,” said Abu Zaid.

Survivors participating in vigorous physical activity appeared to have higher levels of testosterone. Compared with survivors with normal testosterone, survivors with low testosterone were more likely to take medicine for hypertension, dyslipidemia, erectile dysfunction, diabetes, and anxiety or depression.

The researchers will continue to follow this group of survivors and expand the analysis to the entire cohort of 1,600 survivors enrolled on the study to date. “We will never omit cisplatin from the treatment regimen for testicular cancer. Recognizing and treating symptomatic hypogonadism can improve quality of life and lessen adverse health outcomes, especially associated metabolic syndrome and resultant diabetes, hyperlipidemia, and early cardiac problems,” noted Abu Zaid.