Normal Serum Testosterone Levels Research Articles

The impact of testosterone replacement therapy on glycemic control, vascular function, and components of the metabolic syndrome in obese hypogonadal men with type 2 diabetes

Objective: This study set out to assess effects of testosterone replacement therapy (TRT) on parameters of metabolic syndrome and vascular function in obese hypogonadal males with type 2 diabetes mellitus (DM2).Study design: Fifty-five obese hypogonadal diabetic males on oral hypoglycemic treatment were enrolled into this one-year, double-blind, randomized, placebo-controlled clinical study. Group T (n = 28) was treated with testosterone undecanoate (1000 mg i.m. every 10 weeks) while group P (n = 27) received placebo.Methods: Anthropometrical and vascular measurements – flow-mediated dilatation (FMD) and intima media thickness (IMT) – biochemical and hormonal blood sample analyses were performed at the start of the study and after one year. Derived parameters (BMI, HOMA-IR, calculated free testosterone (cFT) and bioavailable testosterone (BT)) were calculated.Results: TRT resulted in reduction of HOMA-IR by 4.64 ± 4.25 (p < .001), HbA1c by 0.94 ± 0.88% points (p < .001), and an increase in FMD by 2.40 ± 4.16% points (p = .005).Conclusion: TRT normalized serum testosterone levels, improved glycemic control and endothelial function while exerting no ill effects on the study population.

Salivary testosterone may not serve as a screening test in the diagnosis of biochemical hyperandrogenism.

The diagnosis of biochemical hyperandrogenism is still challenging because a set of appropriate, recommended diagnostic tests has not been established. In our study, we aimed to answer the question of whether salivary testosterone is a reliable test to establish the diagnosis of biochemical hyperandrogenism as compared to serum total testosterone (TT) measured either by liquid chromatography-tandem mass spectrometry (LC-MS/MS) or immunoassay and to assess which set of biochemical tests would be the most appropriate for the identification of biochemical hyperandrogenism. A total of 39 women, aged 18-45 years, with clinical or biochemical hyperandrogenism and 41 healthy individuals, aged 19-45 years, were enrolled in the study. Salivary testosterone was measured using the Salimetrics test. Serum TT was measured either using the LC-MS/MS method or immunoassay, and dehydroepiandrosterone sulphate (DHEA-S) and androstenedione were measured using LC-MS/MS. In 15 of 17 (88%) patients with elevated serum TT measured by LC-MS/MS and in 14 of 16 (87%) measured with immunoassay, salivary testosterone showed normal levels. In 11 of 39 women (28%) with normal serum testosterone levels, DHEA-S was elevated. All patients with elevated androstenedione presented with an elevated concentration of either serum testosterone or DHEA-S. Salivary testosterone measurement may lead to the underdiagnosis of biochemical hyperandrogenism. Both serum testosterone and DHEA-S should be measured in the endocrine work-up toward biochemical hyperandrogenism.

107 Preservation of Normal Concentration of Pituitary Gonadotropins Despite Achievement of Normal Serum Testosterone Levels in Hypogonadal Men Treated with 4.5% Nasal Testosterone Gel (Natesto)

One well-recognized limitation of standard testosterone treatments is impaired spermatogenesis via suppression of the pituitary hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). We report here the results of treatment with a 4.5% intranasal testosterone gel (Natesto®), on serum total testosterone (TT), LH, and FSH in hypogonadal men. Hypogonadal men were randomized into a 90-day, open-label, dose-ranging study. 4.5% intranasal testosterone gel (125 uL/nostril, 11.0mg testosterone/dose) was self-administered using a multiple-dose dispenser either twice daily (BID, n=122) or 3 times a day (TID, n=151) for a total dose of 22.0mg or 33.0mg, respectively. Titration was performed based on blood levels so as to achieve the eugonadal range (300 -1050 ng/dL). Serum samples were obtained at baseline and after 90 days of treatment to determine relevant hormone levels. Total serum testosterone increased from a mean Cavg 200.8 ng/dL at baseline to a mean Cmax 818.49 ng/dL at ∼40 minutes. After 90 days, 90% (95% CI = 83-97%) of men in the TID group, and 71% (95% CI = 62-79%) of men in the BID group reached normal T levels, and a mean total testosterone Cavg 421 ng/dL and 375 ng/dL, respectively. Baseline FSH (BID) was 8.49 IU/L, mean at Day 90 was 5.99 IU/L. Baseline FSH (TID) was 6.42 IU/L, mean at Day 90 was 3.12 IU/L. Baseline LH (BID) was 5.42 IU/L, mean at Day 90 was 3.56 IU/L. Baseline LH (TID) was 5.25 IU/L, mean at Day 90 was 2.20 IU/L.

Longer TA repeat but not V89L polymorphisms in the SRD5A2 gene may confer acne risk in the Chinese population.

IntroductionSeveral studies have reported that the V89L and TA repeat polymorphisms [(TA)n] of the SRD5A2 gene were associated with SRD5A2 activity. The activity of dihydrotestosterone, which is converted from testosterone by SRD5A2, is responsible for sebum secretion and the formation of acne. We hypothesized that abnormalities in SRD5A2 action could contribute to the formation of acne.AimTo study whether the structural change of the SRD5A2 gene may affect the risk of acne in patients with normal serum testosterone levels.Material and methodsGenotyping of rs523349 and (TA)n of SRD5A2 was performed in 49 Chinese acne patients with significant improvements with SRD5A2 inhibitor-finasteride but normal serum testosterone levels, and in 50 healthy Chinese age-matched controls without acne.ResultsThere was no significant difference between the two groups in the frequencies of V and L alleles and VV, VL, and LL genotypes of V89L (χ2 test, p > 0.5). (TA)n polymorphic repeat sites are 5 alleles (TA0, TA3, TA6, TA9, TA12) in our population. The differences in S and L allele frequencies between the two groups were statistically significant (p < 0.005). People with a longer (n ≥ 6) allele of the (TA)n repeat polymorphism had a higher risk of having acne than those with a shorter (n < 6) allele (OR = 3.52, 95% CI: 1.73–7.16).ConclusionsThis study suggests that SRD5A2 polymorphisms might be associated with acne risk. This is the first report focusing on the Chinese population according to our knowledge. Further large sample studies may be required to confirm the association and to assess any interactions with environmental factors.

Treatment of left varicocele by microsurgical external ligation of spermatic vein in 105 cases

Objective To investigate the efficacy of microsurgical subinguinal varicocelectomy for unilateral varicocele. Methods One hundred and five cases with left side varicocele were enrolled from August 2012 to October 2016.Thirty one cases suffered from varicocele in Ⅱ degree, and other seventy four cases in Ⅲ degree. Clinical data including operation time, sperm quality, testosterone level, complications and natural pregnoncy rate were retrospectively analyzed. The measurement data were expressed by ±s. Sperm concentration, sperm motility, the rate of sperm normal morphology and serum testosterone levels were compared before and after operation with paired t test. Results The average operative time of varicocele was (58±9) minutes in the outer ring of the microscope. Compared with preoperation′s, sperm concentration, sperm motility, the rate of sperm normal morphology was remarkable improved after 3 month. However, serum testosterone levels were steady. In the outpatient follow-up, there were no complications, such as orchiatrophy, hydrocele of tunica vaginalis or recurrence of varicocele. The rate of natural pregnoncy in one year was 46.7%. Conclusions Microsurgical subinguinal varicocelectomy can remarkably improve sperm quality for patients, who suffer from varicocele in Ⅱor Ⅲ degree. The complication of microsurgical subinguinal varicocelectomy is rare. Male infertility patients resulted from varicocele will get favorable natural pregnoncy rate. Key words: Varicocele; Infertility; Microsurgery

Practice Patterns in the Diagnosis and Management of Hypogonadism: A Survey of Sexual Medicine Society of North America Members

To describe practice patterns in the diagnosis and treatment of hypogonadism, as the optimal approaches are controversial. Multiple therapeutic options are currently available for hypogonadal men and treatment patterns vary considerably. The safety of testosterone therapy (TTh) remains understudied. A 23-question survey regarding diagnosis and treatment of hypogonadism was sent to all members of the Sexual Medicine Society of North America. Subgroup analyses compared responses between sexual medicine fellows and non-fellows, as well as between academic and nonacademic physicians, using a chi-squared analysis. A total of 101 responses were included for analysis. The most common cutoff value used to diagnose hypogonadism was 300 ng/dL (55%, range = 200-400 ng/dL), and 31% felt comfortable giving TTh to a symptomatic patient with normal serum testosterone levels. No respondents felt that TTh increased a cardiovascular event risk. Of those surveyed, 68% would prescribe TTh to a hypogonadal man with severe lower urinary tract symptoms, and 64% would offer TTh to a man with low-risk prostate cancer on active surveillance. Fellowship-trained physicians were more likely to prescribe TTh to a man with hypogonadism but normal serum testosterone (P = .038), but they differed in the types of therapy they would use for men with hypogonadism who wish to preserve or regain fertility. Significant variety exists in the diagnosis and treatment of hypogonadism. The majority of physicians will only prescribe TTh in the setting of subnormal serum testosterone levels, despite the presence of symptoms. None of the surveyed physicians reported concern over the risk of cardiovascular events.

Serum testosterone levels and other determinants of sperm retrieval in microdissection testicular sperm extraction.

BackgroundMicrodissection testicular sperm extraction (microTESE) has become the standard of care for sperm retrieval in non-obstructive azoospermia (NOA) patients. Understanding the significant determinants of microTESE outcomes may result in improvements in sperm retrieval rates and provide better-informed clinical decisions.MethodsThis is a clinical retrospective study conducted through chart review of 421 NOA patients who underwent microTESE between August 2009 and July 2015 in a tertiary-care referral hospital. Clinical, biochemical and histopathological characteristics were collected. Normal serum testosterone level was defined as testosterone >9.9 nmol/L. Multiple logistic regression was used to identify determinants of microTESE in the studied population. A P<0.05 was considered significant.ResultsSperms were successfully retrieved in 39.4% of cases. The average testosterone level was 11.51±7.40 and 11.67±6.42 in patients with successful and unsuccessful microTESE, respectively (P=0.820). No significant association was found between serum testosterone level and sperm motility and amount. Of all variables, histological subtype remained to be the most significant determinant of microTESE outcomes in the examined population, with hypospermatogenesis having over a 3-fold higher odd of successful microTESE than sertoli-cell only.ConclusionsSerum testosterone level appears to have no significant association with microTESE outcomes in NOA. The underlying histological pattern is a significant determinant of the procedure’s success.

MP46-04 HIGH PREVALENCE OF LOW SERUM TESTOSTERONE LEVELS AMONG ARTIFICIAL URINARY SPHINCTER PATIENTS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy1 Apr 2017MP46-04 HIGH PREVALENCE OF LOW SERUM TESTOSTERONE LEVELS AMONG ARTIFICIAL URINARY SPHINCTER PATIENTS Travis Pagliara, Jeremy Scott, Boyd Viers, and Allen Morey Travis PagliaraTravis Pagliara More articles by this author , Jeremy ScottJeremy Scott More articles by this author , Boyd ViersBoyd Viers More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1443AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent evidence suggests that low serum testosterone (LST) may be associated with artificial urinary sphincter (AUS) cuff erosion. While the role of androgen replacement therapy is currently poorly defined among men receiving AUS placement surgery, the prevalence of LST among AUS patients is also unknown. We report the prevalence of LST relative to other associated risk factors among a large group of men undergoing AUS placement at a single high-volume institution. METHODS We retrospectively reviewed all men undergoing AUS procedures by a single surgeon from 2012-2016 to identify those men with pretreatment total serum testosterone levels. LST was defined as less than 280 ng/dL. All low serum testosterone levels underwent confirmatory testing. Clinical characteristics were compared between men with and without LST levels. RESULTS Among 85 AUS patients having pretreatment serum testosterone levels available for review, nearly half (41/85, 48%) met criteria for LST. After excluding those patients on androgen deprivation therapy (N=13), 28 of 72 (29%) had primary LST levels. AUS cuff erosion was more common among men with LST levels (38% vs 9%, p=0.01). The median total serum testosterone level among men undergoing AUS placement was 331ng/dL (IQR 192-447). Testosterone levels were drawn at a median 1.5 months (IQR 0-5.8) before AUS surgery. Men with LST levels were more likely to have a history of coronary artery disease (88% vs 30%, p=0.002) and a trend in greater body mass index (mean 31 vs 28, p=0.09) relative to those with normal serum testosterone levels. There was no difference in patient age, history of radiation, time from cancer therapy, erectile dysfunction, or other comorbidities. CONCLUSIONS Approximately one-half of men with stress urinary incontinence undergoing AUS placement present with LST levels. Accordingly, given the association between LST and AUS cuff erosion, men with risk factors for LST should undergo further evaluation prior to SUI surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e620 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Travis Pagliara More articles by this author Jeremy Scott More articles by this author Boyd Viers More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Direct Reprogramming of Mouse Fibroblasts toward Leydig-like Cells by Defined Factors.

SummaryLeydig cells (LCs) play crucial roles in producing testosterone, and their dysfunction leads to male hypogonadism. LC transplantation is a promising alternative therapy for male hypogonadism. However, the source of LCs limits this strategy for clinical applications. Here, we report our success in reprogramming mice fibroblasts into LCs by expressing three transcriptional factors, Dmrt1, Gata4, and Nr5a1. The induced Leydig-like cells (iLCs) expressed steroidogenic genes, had a global gene expression profile similar to that of adult LCs, and acquired androgen synthesis capabilities. When iLCs were transplanted into rats or mice testes that were selectively depleted of endogenous LCs, the transplanted cells could survive and function in the interstitium of testis, resulting in the restoration of normal levels of serum testosterone. These findings demonstrate that the fibroblasts were able to be directly converted into iLCs by few defined factors, which may facilitate future applications in regenerative medicine.

Cross-sectional association between physical activity and serum testosterone levels in US men: results from NHANES 1999-2004.

Testosterone levels and physical activity each play important roles in men's health, but the relationship between the two remains unclear. We evaluated the cross-sectional association between self-reported total physical activity and serum testosterone levels in 738 men (mean age 42.4years, range 20-≥85years) who participated in National Health and Nutrition Examination Survey 1999-2004. We compared geometric mean testosterone concentrations measured by radioimmunoassay (RIA) and calculated the odds ratio (OR) of having low or low normal testosterone (≤3.46ng/mL) across tertiles of total physical activity in all men, and men stratified by age (20-49, ≥50years), and obesity status (BMI<30, ≥30kg/m(2) ). The geometric mean testosterone concentration was 5.31ng/mL; 18.6% of the men had low or low normal serum testosterone levels. Physical activity tertiles were not associated with testosterone levels overall, or when stratified by age or obesity status. Similarly, there was no association between physical activity tertiles and the odds of low or low normal testosterone, overall or by age. However, among non-obese men, those in the highest physical activity tertile were significantly less likely to have low or low normal testosterone than those in the lowest tertile (OR 0.50; 95% CI=0.26-0.95); there was no association among obese men. Greater physical activity was not associated with testosterone levels, but may be associated with a reduced odds of low or low normal testosterone in non-obese men, but not in obese men.

Effects of vitamin D and quercetin, alone and in combination, on cardiorespiratory fitness and muscle function in physically active male adults.

IntroductionVitamin D and the antioxidant quercetin, are promising agents for improving physical performance because of their possible beneficial effects on muscular strength and cardiorespiratory fitness.PurposeThe purpose of this study was to determine the effects of increased intakes of vitamin D, quercetin, and their combination on antioxidant status, the steroid hormone regulators of muscle function, and measures of physical performance in apparently healthy male adults engaged in moderate-to-vigorous-intensity exercise training.MethodsA total of 40 adult male participants were randomized to either 4,000 IU vitamin D/d, 1,000 mg/d quercetin, vitamin D plus quercetin, or placebo for 8 weeks. Measures of cardiorespiratory fitness and muscle function, blood markers for antioxidant and vitamin D status, and hormones 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) and testosterone were measured pre- and postsupplementation.ResultsAt enrollment, 88.6% of participants were vitamin D sufficient (serum 25-hydroxyvitamin D >50 nmol/L) and had normal serum testosterone levels. Supplementation with vitamin D significantly increased serum 25(OH)D concentration (by 87.3% in the vitamin D group, P<0.001) and was associated with an increasing trend of testosterone concentration. There were no changes in concentration of 1,25(OH)2D3 and markers of antioxidant status associated with vitamin D or quercetin supplementation. No improvements in physical performance measures associated with vitamin D and quercetin supplementation were found.ConclusionThe findings obtained demonstrate that long-term vitamin D and quercetin supplementation, alone or in combination, does not improve physical performance in male adults with adequate vitamin D, testosterone, and antioxidant status.

Testis sparing surgery in the treatment of bilateral testicular germ cell tumors and solitary testicle tumors: A single institution experience.

To assess the oncologic and functional outcomes of testicular sparing surgery (TSS) based on a single institution experience. Forty-one patients with bilateral and 3 patients with solitary testicle tumors were referred to our institution. The inclusion criteria for TSS were normal serum testosterone levels, and tumor size (<2 cm). Sperm analysis and hormone status evaluation were performed preoperatively and postoperatively. None of the patients underwent local radiation therapy following TSS for reasons of fertility preservation. A total of 26 TSS were performed in 24 patients. The median follow-up period was 51.0 months. Seven patients developed local recurrence, of which 5 had TIN and were subjected to radical orchiectomy, whereas re-do TSS was done in remaining 2 patients. The overall survival of the study group was 100%, and the presence of testicular intraepithelial neoplasia (TIN) was associated with worse recurrence-free survival (P=0.031, log-rank). Testosterone values were normal in all of the patients, while 4 patients achieved conception. TSS is acceptable from an oncological point of view, and it enables continuation of a patient's life without lifelong hormonal substitution. Additionally, local irradiation therapy could be delayed in patients with TIN who wish to father children, but with high local recurrence rate.

Extra X Chromosome in Mosaic Klinefelter Syndrome Is Associated with a Hematologic Malignancy

Extra X Chromosome in Mosaic Klinefelter Syndrome Is Associated with a Hematologic Malignancy

Sertoli Cell Androgen Receptor Expression Regulates Temporal Fetal and Adult Leydig Cell Differentiation, Function, and Population Size

We recently created a mouse model displaying precocious Sertoli cell (SC) and spermatogenic development induced by SC-specific transgenic androgen receptor expression (TgSCAR). Here we reveal that TgSCAR regulates the development, function, and absolute number of Leydig cells (LCs). Total fetal and adult type LC numbers were reduced in postnatal and adult TgSCAR vs control testes, despite normal circulating LH levels. Normal LC to SC ratios found in TgSCAR testes indicate that SC androgen receptor (SCAR)-mediated activity confers a quorum-dependent relationship between total SC and LC numbers. TgSCAR enhanced LC differentiation, shown by elevated ratios of advanced to immature LC types, and reduced LC proliferation in postnatal TgSCAR vs control testes. Postnatal TgSCAR testes displayed up-regulated expression of coupled ligand-receptor transcripts (Amh-Amhr2, Dhh-Ptch1, Pdgfa-Pdgfra) for potential SCAR-stimulated paracrine pathways, which may coordinate LC differentiation. Neonatal TgSCAR testes displayed normal T and dihydrotestosterone levels despite differential changes to steroidogenic gene expression, with down-regulated Star, Cyp11a1, and Cyp17a1 expression contrasting with up-regulated Hsd3b1, Hsd17b3, and Srd5a1 expression. TgSCAR males also displayed elevated postnatal and normal adult serum testosterone levels, despite reduced LC numbers. Enhanced adult-type LC steroidogenic output was revealed by increased pubertal testicular T, dihydrotestosterone, 3α-diol and 3β-diol levels per LC and up-regulated steroidogenic gene (Nr5a1, Lhr, Cyp11a1, Cyp17a1, Hsd3b6, Srd5a1) expression in pubertal or adult TgSCAR vs control males, suggesting regulatory mechanisms maintain androgen levels independently of absolute LC numbers. Our unique gain-of-function TgSCAR model has revealed that SCAR activity controls temporal LC differentiation, steroidogenic function, and population size.

Serum cortisol and testosterone levels in chronic central serous chorioretinopathy

To investigate the potential role of serum cortisol and testosterone levels in chronic central serous chorioretinopathy (CSC). Serum cortisol and testosterone levels of six male patients with chronic CSC were evaluated by chemiluminescent immunassay. Hormone levels were compared with the normal reference values of healthy people. All patients were male, and the median age was 48 years (range: 42-54). The median duration of visual disturbance at presentation was 23 months (range: 12-48). Median 8:00 a.m. serum cortisol level was 11.6 μg/dl (min. 4.74, max. 18.3) and the cortisol levels were within the normal range in five of the six patients. All patients had normal serum testosterone levels, with a median value of 549.5 ng/ml (min. 246, max. 794). Serum cortisol and testosterone levels were within normal ranges and in patients with chronic CSC. The association between these hormones and chronic CSC might be weak.

One‐Year Efficacy and Safety Study of a 1.62% Testosterone Gel in Hypogonadal Men: Results of a 182‐Day Open‐Label Extension of a 6‐Month Double‐Blind Study

A new formulation of testosterone gel (1.62% testosterone gel) with increased viscosity and reduced volume of application has been shown to be safe and efficacious after 182 days of use in a phase 3, double-blind study in adult hypogonadal males. The objective of this study was to evaluate the efficacy and safety of the 1.62% testosterone gel after daily application to the skin in a 182-day (6-month) open-label extension of the initial 182-day double-blind study. One hundred and sixty-three subjects, aged 26 to 77 years, continued on active (Continuing Active subjects) 1.62% testosterone gel for the remainder of the study (364 days total). In 28 subjects who had previously received placebo (Formerly Placebo subjects), the dose was titrated to normal levels of serum total testosterone (300-1,000 ng/dL). Dose adjustments for both groups were allowed at specific visits to maintain serum testosterone within a normal range. The main outcome measure was the percentage of subjects with serum total testosterone average concentrations (C(av) ) within the normal range at day 364. On day 364, 77.9% (95% confidence interval: 70.0, 84.6) of the Continuing Active subjects and 87.0% (66.4, 97.2) of the Formerly Placebo subjects had C(av) values within the eugonadal range. The 1.62% testosterone gel was safe and well tolerated in this study. Treatment with 1.62% testosterone gel for up to 1 year (182 days for the Formerly Placebo subjects, 364 days for the Continuing Active subjects) was safe and efficacious, resulting in >77% of treated subjects achieving normal serum testosterone levels at final visit.

Protective effects of tripterygium glycoside-loaded solid lipid nanoparticles on male reproductive toxicity in rats

The protective effects of tripterygium glycoside-loaded solid lipid nanoparticles (TG-SLNs) on male reproductive toxicity were investigated in rats. Thirty-six male Sprague-Dawley rats were randomly divided into three groups of 12: control group, tripterygium glycoside (TG) group, and TG-SLN group. After the animals had been orally administered with the substances for 28 consecutive days, their sperm count and sperm motility, organ coefficients, serum testosterone levels, testicular ultrastructure, and reproductive ability were observed. The results showed that the sperm motility rate in the TG group was only 3%, whereas the rates in the TG-SLN and control groups were 33% and 71%, respectively. Compared with those in the control group, the motion counts of path velocity, track speed, progressive velocity, straightness, linearity, beat cross frequency, amplitude of lateral head displacement, and sperm concentrations in the TG-SLN group were not significantly different while those in the TG group significantly decreased (p < 0.01). TG-SLNs did not cause testicular atrophy and instead maintained normal serum testosterone levels. The effect of TG-SLNs on the testicular ultrastructure was very evident; the morphologies of Sertoli, spermatogonial, mitochondrial, and sperm cells were normal. In terms of reproductive ability, one rat (17%) from the TG-SLN group and five rats (83%) from the control group became pregnant, whereas none of the rats from the TG group became pregnant. These data indicate that TG-SLNs have potentially protective effects on male reproductive toxicity in rats.

Alternate indications for varicocele repair: non-obstructive azoospermia, pain, androgen deficiency and progressive testicular dysfunction

Varicocele repair is indicated for infertile men with clinical varicoceles. Some men with scrotal pain, low testosterone, non-obstructive azoospermia, and who are at risk for testicular dysfunction may also benefit from varicocelectomy.

Testosterone recovery after permanent prostate seed implantation in patients with neoadjuvant hormonal therapy.

e15067 Background: The PSA kinetics in patients undergoing prostate brachytherapy with neoadjuvant hormonal therapy (NHT) is dependent on the recovery of serum testosterone(T) levels. When NHT was done, determination of PSA nadir is sometimes very confusing because of variety pattern of testosterone recovery. In this study, we assessed the duration of testosterone recovery and its effect on PSA kinetics in Asian (Japanese) men. Methods: From March 2004 to September 2010, 612 patients underwent I125 seed implantation in our institution. The records of 306 patients with NHT and a minimum of 2 years of follow-up were reviewed. Among those, 243 had serum testosterone level measurement every 3-6 months. All patients had at least 2 years of follow-up and were ceased androgen ablation after seed implantation. Prognostic factors for testosterone recovery were examined using multivariate Cox regression analysis. Results: Of 243 patients (age 48-81) with T1-T2 N0M0 prostate cancer, 207 had appropriate data. NHT included maximum androgen blockade (MAB) in 47 patients (22.7%), LHRH analog (LHRHa) in 157 (75.8%) and anti-androgen agent in 3(1.5%). The median duration of NHT was 11 months (range 3-72M). 94.7% of patients (n=196) recovered normal T levels (7.2 nmol/l) and median time to recover was 6.9 months (MAB group 9.0M, LHRHa group 6.5M). When PSA nadir was defined after 6.9M (207 days) of brachytherapy, 2 patients (4.3%) had biochemical failure (BF; nadir+2ng/dl) and 2 (4.3%) had PSA bounce (PB) in MAB group while 3 patients (1.9%) had BF and 7 (4.5%) had PB in LHRHa group. Total BF free rate was 5.8% and PSA bounce rate was 16.0%. 11 patients (5.3%, median NHT duration 10 months) did not recover normal T levels. On multivariate analysis, younger age (p=0.016, 95% C.I. 0.945-0.994) and the use LHRHa as compared with MAB (p=0.004. 95% C.I. 0.028-0.504) could be the prognostic factors for testosterone recovery. The duration of NHT was not significant (p=0.211) in this study. Conclusions: 78.3% and 95.4% of patients recovered normal serum testosterone levels within a year and 2 years, respectively. Defining PSA nadir according to T recovery seems useful in appropriate follow-up of patients undergoing brachytherapy with NHT.

Role of Androgen Deprivation Treatment in Patients With Castration-Resistant Prostate Cancer, Receiving Docetaxel-Based Chemotherapy

To assess the impact of continued androgen deprivation therapy (ADT) in patients with castration-resistant prostate cancer (CRPC) receiving first-line docetaxel-based chemotherapy. A retrospective review was performed on 78 patients fulfilling the criteria for CRPC who were treated with docetaxel-based chemotherapy over 5 years. Thirty-nine patients received concurrent ADT (ADT group), whereas 39 patients discontinued ADT (No-ADT group). PSA response rates were 66.7% for ADT patients and 48.7% for No-ADT patients (P = 0.27). The median progression-free survival and overall survival were 5.0 months and 24.8 months for ADT patients and 4.9 months and 22.1 months for No-ADT patients, respectively (P = 0.57, P = 0.94). Follow-up testosterone levels were available in 13 patients of the No-ADT group and none of them recovered a normal serum testosterone level over a median follow-up duration of 8.3 months from ADT discontinuation. ADT was recommenced in 21 of 39 patients in the No-ADT group and, of these, 6 (29%) achieved a PSA response. Clinical outcomes were not significantly different when patients with CRPC received concurrent ADT, or were not so treated, when receiving first-line docetaxel-based chemotherapy. Despite ADT withdrawal, serum testosterone level did not recover to the noncastrated level during the period of chemotherapy, and reinduction of hormone sensitivity occurred in about one-quarter of patients.