Testicular Cancer Survivors Face Low Testosterone Levels

While nearly are cases of testicular cancer are curable, many patients experience low testosterone (hypogonadism) and associated adverse events, according to a study presented at the 2017 American Society of Clinical Oncology Annual Meeting.

"We can now cure 19 out of 20 cases of testicular cancer, but a significant number of testicular cancer survivors have low testosterone, and that can affect other aspects of their health,” said Timothy D. Gilligan, MD, MSc. “Based on this study and others, clinicians should ask testis cancer survivors whether they have symptoms of low testosterone and should watch for signs of associated health problems.”

Included in the study were 491 patients who survived testicular cancer. The Platinum Study is currently ongoing and includes more than 1600 survivors. All patients included in the study received chemotherapy and were younger than 55 years at diagnosis.

The goal of the study is to follow the health of patients who were treated with cisplatin chemotherapy. The investigators collected data from questionnaires, blood samples, and basic testing. The authors also examined genes that may play a role in developing long-term health issues.

The authors discovered that 38% of the 491 patients had hypogonadism. Compared with patients who had normal hormone levels, those with hypogonadism were more likely to have chronic diseases.

Compared with patients with normal hormone levels, patients with hypogonadism were more likely to take medication for high cholesterol (6% versus 20%), hypertension (11% versus 19%), erectile dysfunction (12% versus 20%), diabetes (3% versus 6%), and anxiety or depression (10% versus 15%), according to the study.

"Some of these health problems have been previously linked to low testosterone levels among men in the general population and in a few studies of testicular cancer survivors, but this study is one of the most comprehensive to date -- we are looking at 15 different health conditions," said lead study author Mohammad Issam Abu Zaid, MBBS.

Interestingly, the authors discovered that patients who participated in rigorous physical activity had higher levels of testosterone. These findings suggest that exercise may present additional benefits for these patients.

The investigators also found that an abnormality in the sex hormone binding globulin gene that may increase the risk of hypogonadism, but this finding needs to be confirmed in larger studies, according to the study.

The researchers are planning to follow the participants and expand the analysis to include all study subjects. They also plan to explore the effects of testicular cancer surgery versus chemotherapy and assess the differences in adverse health outcomes and testosterone levels, according to the study.

"Because testicular cancer occurs at a young age and is highly curable, many survivors may live upwards of five decades," Dr Abu Zaid said. "Our findings underscore the need for clinicians to assess testicular cancer survivors for physical signs or symptoms of hypogonadism and to measure testosterone levels in those who do."