Abstract
Testicular tumors and their treatment interfere with homeostasis, hormonal status included. The aim of the study was to evaluate hormonal disorders of the pituitary–gonadal axis in men treated for testicular tumors. One hundred twenty-eight men treated for a unilateral testicular tumor at our institution were included. The hormonal status was prospectively evaluated in 62 patients before orchiectomy, 120 patients 1 month after orchiectomy and 110 patients at least 1 year after the treatment. The concentrations of human chorionic gonadotropin (hCG), testosterone (T), estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin were measured. The clinically significant testosterone deficiency was defined either as testosterone <2.31 ng/mL or testosterone within the range of 2.31–3.46 ng/mL but simultaneous with T/LH ratio ≤1. Changes in hormone levels were significant: LH and FSH rose in the course of observation, and the concentration of hCG, testosterone, estradiol decreased. PRL concentration was the lowest at 1 month after orchiectomy. In multivariate analysis, the risk of the clinically significant testosterone deficiency was 0.2107 (95% CI 0.1206–0.3419) prior to orchiectomy, 0.3894 (95% CI 0.2983–0.4889) 1 month after surgery and 0.4972 (95% CI 0.3951–0.5995) 1 year after the treatment. The estradiol concentration was elevated in 40% of patients with recently diagnosed testicular cancer and that was correlated with a higher risk of testosterone deficiency after the treatment completion. Hormonal disorders of the pituitary–gonadal axis in men treated for testicular tumors are frequent. The malignant tissue triggers paraneoplastic disorders that additionally disturb the hormonal equilibrium.
Highlights
Affecting mostly Caucasian males aged 15–40, testicular germ cell tumors represent the most common malignancy in this age group
Even in the ‘poor prognosis’ group of metastatic non-seminoma, 48–60% can still be cured with first-line chemotherapy [1]
We observed a significant decrease in testosterone concentration directly after orchiectomy
Summary
Affecting mostly Caucasian males aged 15–40, testicular germ cell tumors represent the most common malignancy in this age group. The prognosis remains excellent, especially in testicle-limited (stage I) tumors. Overall survival rates reach 99% for stage I seminomas. Even in the ‘poor prognosis’ group of metastatic non-seminoma, 48–60% can still be cured with first-line chemotherapy [1]. Older patients ([65 years) with germ cell tumors, believed to have a worse prognosis, achieve a survival rate as high as 72–83% [2]. Often combined with surgery and radiotherapy, chemotherapy has been the cornerstone of the treatment. New approaches such as high-dose chemotherapy with autologous stem cell transplant
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