STOCKHOLM, SWEDEN (UroToday.com) - There is significant morbidity related to long-term androgen deficiency. 12-16% of testis cancer survivors have overt hypogonadism, and around 15% have subclinical hypogonadism. Hypogonadism can predispose to metabolic syndrome, which can double the risk of cardiovascular disease. Most cardiovascular disease among testis cancer survivors becomes apparent after more than 10 years.
For patients with testosterone levels in the lower range of normal, there is currently no evidence to support testosterone supplementation. However, increased luteinizing hormone (LH) levels among men with “normal” testosterone levels could indicate compensated hypogonadism. Data was presented revealing an increase in LH levels following orchiectomy among men with stage I testis cancer, despite normal testosterone levels. 57% of patients were outside the 97.5th percentile at 1-year follow-up, suggesting Leydig cell insufficiency. Further examination of LH, testosterone, and FSH levels was performed in 307 patients treated for stage 1 or disseminated disease at 14-28 years of follow-up. Among 233 patients with stage 1 disease, hypogonadal levels of testosterone were present in 10% after surgery, while LH was higher in 9%. Following radiotherapy, testosterone levels were below normal in 19%, and LH was higher in 21%. Among patients with stage 1 and 2 disease, 55% and 63%, respectively, had testosterone levels in the lowest quartiles.
Finally, significant late cardiovascular events occur following testis cancer treatment. Following radiation and chemotherapy, there is a 2.8- and 4.5-fold increased risk of any cardiovascular event or cardiovascular death, respectively. Among patients treated with radiation therapy alone, a 1.4-fold increased hazard of cardiovascular death was observed. In conclusion, serious health concerns such as weight gain, reduced muscle mass, increase in body fat, and change in lipids can be associated with hypogonadism. These may lead to potentially more serious conditions, such as hypertension, diabetes, and coronary artery disease. Late side effects require more systematic study in clinical trials, and there is currently no evidence to support testosterone supplementation in those with testosterone levels in the lower range of normal. Large-scale studies of survivors are needed to describe morbidity related to long-term androgen deficiency.
Presented by G. Daugaard at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden.
Written by Jeffrey J. Tomaszewski, MD, medical writer for UroToday.com