Presentation Authors: Madeleine L. Burg*, Zhoobin H. Bateni, Shane M. Pearce, Jamal Nabhani, Hooman Djaladat, Anne K. Schuckman, Siamak Daneshmand, Los Angeles, CA
Introduction: Men with testicular germ cell tumors (TGCT) are known to have gonadal dysfunction even before orchiectomy. Few studies have examined gonadal function long-term after orchiectomy or completion of chemotherapy (CTx). We aimed to determine hormone abnormalities after orchiectomy and/or CTx.
Methods: Using an IRB approved TGCT database, patients were reviewed for post-orchiectomy hormone levels including total testosterone (Total T), free testosterone (Free T), follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and sex hormone binding globulin (SHBG). Patients on testosterone replacement therapy at time of blood draw or history of bilateral orchiectomies were excluded. Hormones were recorded as continuous variables and as normal, low, or elevated. Additional variables included prior treatment received and most recent treatment date before blood draw. Any patient who received CTx had most recent prior CTx treatment date used. Univariate analyses were performed.
Results: 100 patients had hormones available. Median age was 31 years and not associated with a difference in hormone levels. Eight patients (n=99, 8.1%) had low Total T and 7 patients (n=67, 10.5%) low Free T. Remaining results reported in Table 1. Median time since last treatment prior to blood draw was 219 days (IQR 70-611 days). 55 patients (55%) had undergone cisplatin CTx prior to blood draw with median of 133 days since last treatment. Receipt of CTx was associated with elevated FSH (mean values 20.9 vs. 9.8 mIU/mL, p=0.0003) and elevated LH (mean values 13.0 vs. 7.0 mIU/mL, p=0.0001). There was no difference in Total T (mean values 436 vs. 448 ng/dL), Free T (66.5 vs. 69.8 ng/dL), estradiol (25.6 vs. 26.2 pg/mL), or SHBG (36.6 vs. 35.6 nmol/L) between those who did or did not receive CTx, respectively. Among those who received CTx more than 2 years prior (n=10, median age 33 years), 4 patients had elevated LH (40%).
Conclusions: About 8 to 10% of men with TGCT are hypogonadal following orchiectomy, which is higher than reported overall age-adjusted population rates. Those who received CTx have significantly higher FSH and LH levels. Further longitudinal studies are needed to determine whether patients with history of TGCT and receipt of cisplatin CTx are at increased risk for eventual secondary hypogonadism.