BERKELEY, CA (UroToday.com) - Orchiectomy, followed by active surveillance, is becoming the preferred treatment option for patients with stage I testicular cancer in all large centers in the world.
This is due to the fact that survival is approaching 100%, both when adjuvant treatment is given to all patients, and when adjuvant treatment is reserved for the 20% to 30% of patients who are initially followed by active surveillance and then relapse.
Here we evaluate the levels of testosterone and luteinizing hormone (LH) one year after orchiectomy in patients with unilateral testicular cancer stage I, and compare the levels with a group of randomly chosen age-matched controls. Also we use a joint evaluation of LH and testosterone in order to detect changes that cannot be detected by evaluating either of the hormones alone. Thus, a high LH combined with a testosterone that is low in the normal range is a sign of compensated testicular failure and this will be detected by joint evaluation of the two hormones. We show that one year after orchiectomy there is a significant increase in LH, and that 57% of the patients have an LH/testosterone relation outside the limits of normality despite normal testosterone levels. Thus, they are showing signs of compensated testicular insufficiency.
Moreover we evaluated a subgroup of patients with human chorionic gonadotropin (hCG) producing testicular tumors, and suggest that these patients should be evaluated separately, since hCG disturbs the pituitary-Leydig cell axis by its homogenicity to LH. This results in suppressed LH levels and high levels of testosterone and estradiol in this subgroup of patients. It is well-known that hypogonadism is associated with obesity, decreased bone mineral density, decreased muscle mass, dyslipidemia and psychological symptoms; and clinical guidelines suggest androgen substitution when there are biochemical signs as well as symptoms of hypogonadism.
None of the patients included in this study developed manifest hypogonadism one year after orchiectomy, but the fact that a majority of the patients needed a greater LH-drive to keep testosterone within its normal range makes us advocate for closer surveillance of testicular hormonal function also in patients treated with orchiectomy alone in order to detect and treat hypogonadism before associated conditions develop. We suggest annual or bi-annual measurements of LH and testosterone.
Mikkel Bandak as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.