Presentation Authors: Woodson Smelser*, Eugene Lee, Ajay Nangia, Katherine Glavin, Jeffrey Holzbeierlein, Kansas City, KS
Introduction: Radical cystectomy (RC) is associated with significant morbidity, and loss of body weight is a common after RC, even in patients without 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. We hypothesize that hypogonadism is prevalent in male patients undergoing RC for bladder cancer (BC), and that it persists in the post-operative period.
Methods: We implemented a prospective, IRB-approved trial (Clinical trials.gov # NCT03063125) 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 undergoing RC. Pre-operative total (TT), free testosterone and luteinizing hormone (LH) were obtained. These labs were then repeated on post-operative days 2, 3, 30, and 90. The threshold for normal total testosterone was defined as >300 ng/dl. Demographic data were recorded.
Results: From March 2017-March 2018, 25 patients were enrolled into the study. Twenty-three men completed the trial. Mean patient age was 68.9 years (52-85). The mean pre-operative TT was 308 ng/dl (range 50-566 ng/dl) and 12/23 (52.5%) patients had HG. Three patients had abnormal pre-operative LH levels (range 21-57 mIU/L). Mean post-operative day TT was 166 ng/dl (range 32-345). 19/20 (95%) of men had HG. In total, 7 men (30%) who were eugonadal pre-op migrated into hypogonadism post-operatively. Mean post-operative day 30 TT was 253 ng/dl (range 40 -518) and 12/19 (63%) patients who had labs drawn were hypogonadal. At post-op day 90, 37% of men who had AM labs drawn had HG.
Conclusions: Hypogonadism is prevalent in men undergoing RC; our trial demonstrates a pre-op immediate post-op, and 30 day post-operative prevalence of 52%, 95%, and 37.5% respectively. Furthermore, HG persisted beyond the immediate post-operative period. Treatment of peri-operative HG with correction to a eugonadal state may represent a therapeutic intervention to reduce the morbidity associated with radical cystectomy.