917P - A single centre retrospective review of testosterone deficiency in germ cell cancer patients

Abstract

Background: Testosterone deficiency syndrome (TDS) is frequently described in men treated for germ cell cancer with rates quoted between 11 and 38% (Huddart et al 2005). Observational studies show that TDS reduces quality of life and carries cardiovascular, metabolic and bone health risks. At our institute we observed that men with symptoms of TDS and ‘low normal’ testosterone (T) (8.6 – 12 nmol/L) were not reliably recognised. Methods: We collected retrospective data from all germ cell cancer referrals to the Bristol Cancer Institute from 2011 – 2016. We documented age, treatment, at least one random T level within a year of diagnosis (grouped into < 8, 8 – 12 and > 12 nmol/L), details of symptoms and treatment of TDS. Results: Data was collected on 462 patients (36 excluded with non germ cell diagnoses and 26 excluded due to T never being measured). Median age was 36 years (range 17 – 89) with 85% of patients aged under 50. 58% of men had seminoma, 32% non-seminoma and 10% combined germ cell cancer. 41% of all patients had a T level < 12 nmol/L at first measurement (32% of 20 – 29 year olds, 42% of 30 – 49 and 58% of 50 – 59 year olds) and 16% had T < 8 nmol/L. T therapy was prescribed in 19% of patients. Men receiving adjuvant carboplatin had the highest rate of T therapy (23%) compared with patients on surveillance (18%) and BEP or EP chemotherapy (14%). Conclusions: In this retrospective series 41% of patients had at least one total T value <12 nmol/L. 19% received replacement. A TDS diagnosis should not be based on a single measurement but regardless of age, once T falls to < 15 nmol/L, severity of TDS sequelae correlate with further decline (Morgentaler et al 2016). There is a range of what is regarded as normal T and it declines naturally with age. Recognition and management of late effects is important in men with curable cancer and diagnosis must be individualised; addressing symptoms alongside biochemical parameters. This is reflected by germ cell cancer social media websites where men frequently describe serum T in the defined normal range with symptoms of TDS. Further prospective multi-centre studies could better define the prevalence of TDS in these patients and be used to inform a standard diagnostic approach. Legal entity responsible for the study: Jeremy Braybrooke Funding: None Disclosure: All authors have declared no conflicts of interest.