ASCO GU 2018: Perioperative Hypogonadism in Men Undergoing Radical Cystoprostatectomy for Bladder Cancer

San Francisco, CA ( Radical cystectomy (RC) is a procedure associated with significant morbidity, commonly accompanied by loss of body weight, even in patients without any significant nutritional deficiencies. Prior studies have demonstrated a high prevalence of hypogonadism (HG) in men with cancer and who undergo anesthesia/major surgery. The suppression of testosterone persists up to seven days following surgery. The authors hypothesized that HG is prevalent in male patients undergoing RC for bladder cancer (BC), with persistence in the post-operative period. 


This was a prospective trial (Clinical # NCT03063125) aiming to prospectively enroll 25 men with no prior history of treatment for HG or other hormonal disorders, with a new diagnosis of non-metastatic bladder cancer, referred for RC. All patients had pre-operative total, free testosterone and luteinizing hormone (LH). These labs were then repeated on post-operative days 2, 3, 30, and 90. The threshold for normal total testosterone was defined as > 250 ng/dl.


25/25 patients had been enrolled and the trial had been closed, but the data were mature enough to present only on 9 patients, enrolled to the trial between March and September 2017. Mean patient age is 68.5 years (52-85). The mean pre-operative total testosterone was 247 ng/dl (range 50-496 ng/dl) and 6/9 (66.7%) patients had preoperative HG. Two patients had abnormal pre-operative LH levels (range 21-57 mIU/L). Testosterone decreased by a mean of 99 ng/dl between pre-op assessment and post-operative day 2 [95% CI 66.2, 131.8]. All 6 men who initially had HG remained below 250 ng/dl. Two men experienced a decrease in their testosterone levels, from an eugonadal state (347 ng/dl, 316 ng/dl) to hypogonadal state (213 ng/dl,192 ng/dl, respectively) by post-operative day 2. At 30 days post-op, the mean T level was 206 ng/dl. No patients had returned to their preoperative baseline levels and 8/9 (88.9%) had HG (range 40-356 ng/dl).


HG is prevalent in men undergoing RC. This trial demonstrates a pre- and 30 day post-operative HG prevalence of 66.7% and 88.9%, respectively. Furthermore, HG persisted beyond the immediate post-operative period. Consideration of treatment of peri-operative HG with correction to a eugonadal state may represent a therapeutic intervention aiming to reduce the morbidity associated with radical cystectomy. Clinical trial information: NCT03063125

Presented by: Woodson Smelser, University of Kansas

Co Authors:  Eugene Lee, Ajay Nangia, Katherine Glavin, Jeffrey M. Holzbeierlein; University of Kansas, Kansas City, KS; University of Kansas Medical Center, Kansas City, KS; University of Kansas Department of Urology, Kansas City, KS

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA