ASCO Annual Meeting
ASCO Annual Meeting
Perspective from David M. Nanus, MD
June 03, 2017
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Low testosterone levels prevalent among testicular cancer survivors

Perspective from David M. Nanus, MD
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CHICAGO – Nearly 40% of testicular cancer survivors had low testosterone levels, known as hypogonadism, according to a study presented at the ASCO Annual Meeting.

Further, survivors with low testosterone levels appeared more likely to have a range of chronic health problems, including high blood pressure, diabetes, erectile dysfunction, night sweats, fatigue, anxiety or depression.

“Testicular cancer is the most common cancer among young men, but 95% of all testicular cancer patients are cured of their disease thanks to cisplatin-based chemotherapy that was first discovered in 1974,” Mohammad Issam Abu Zaid, MBBS, assistant professor of medicine at Indiana University School of Medicine, said during a press conference. “Today, testicular cancer survivors can expect to live for more than 40 years from the time of their diagnosis. However, they are at risk for other health problems that may be related to their cancer treatments, including complications from chemotherapy.”

Men with testicular cancer can present with low testosterone at the time of diagnosis, or can experience a decrease in testosterone as a side effect of surgery or chemotherapy.

Researchers evaluated the relationship between low testosterone and long-term health complications in 491 North American men enrolled in The Platinum Study, which enrolled more than 1,600 survivors of testicular cancer.

All patients received diagnoses at age younger than 55 years and all underwent chemotherapy. Median age at clinical evaluation was 38 years (range, 19-68).

Researchers defined hypogonadism as serum testosterone at or less than 3 ng/mL or the use of testosterone replacement therapy.

At evaluation, 38.5% of patients had a low testosterone level or received testosterone replacement therapy. Older age (OR per 10-year increase = 1.4; P = .007) and higher BMI (25 or more, OR = 2.2; P = .003) appeared associated with lower testosterone.

Researchers also found a genetic abnormality in the sex hormone binding globulin gene that appears to predispose some men to low testosterone, but noted the finding needs to be confirmed in larger studies.

Survivors participating in vigorous physical activity appeared to have higher levels of testosterone, although this did not reach statistical significance (OR = 0.6).

Compared with survivors who had normal testosterone, a greater proportion of those with low testosterone took medicine for high cholesterol (20% vs. 6%), high blood pressure (19% vs. 11%), erectile dysfunction (20% vs. 12%), diabetes (6% vs. 3%), or anxiety or depression (15% vs. 10%).

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“There will always be potential for complications from curative platinum chemotherapy,” Abu Zaid said. “Mitigating approaches include weight control, exercise and monitoring blood pressure and cholesterol levels. Recognizing and treating symptomatic hypogonadism can improve quality of life and reduce adverse outcomes.”

Increasing testosterone levels can help prevent some of the adverse effects associated with chemotherapy in young men treated for testicular cancer, but accurately assessing those levels is challenging, according to Abu Zaid.

“It’s a very muddy field that is not clearly defined,” he said. “Every study uses a different definition for what they consider a low testosterone level. If it is as low as 2 or 3, you probably will treat more patients than necessary. You do not want to treat somebody who does not have symptoms. I would hypothesize that testosterone replenishment would actually help young men. However, in elderly men studies show that increased testosterone levels can carry an increase in cardiac disease. It’s a completely different population.” – by Chuck Gormley

Reference:

Abu Zaid, et al. Abstract LBA10012. Presented at: ASCO Annual Meeting; June 2-6, 2017; Chicago.

Disclosures: The NCI funded this study. Abu Zaid reports no relevant financial disclosures. Please see the abstract for a list of all other researchers’ financial disclosures.