Early androgen deficiency in testicular germ cell cancer patients

Objective: To investigate the risk for developing testosterone deficiency in patients after testicular germ cell cancer (TGCC) treatment.

Material and Methods: 376 patients are prospectively examined for their serum testosterone levels (normal range: >2.84 ng/ml or >9.85 nmol/l) after oncological treatment for TGCC. Until now, serum hormone analyses were performed on 132 patients (age: 33.8±9.1 years, mean±SD) prior to treatment and at least three times during their clinical follow-up in our department. In addition, all patients were assessed for symptoms of androgen deficiency with a standardized rating scale (Heinemann et al. 2001: The Aging Male's Symptoms Rating Scale).

Results: Statistical analysis of 1831 pre- and posttherapeutical testosterone serum levels showed a persisent testosterone deficiency in 17 out of 71 patients with seminoma (age 37.0±8.2 years) and in 16 out of 61 patients with non-seminoma (age 31.2±9.1 years). With regard to the different oncological treatment options 17 of the 33 hypogonadal patients received cisplatin-based polychemotherapy, six patients carboplatin monotherapy, 7 patients retroperitoneal radiotherapy and 3 patients surgery only.

Conclusions: Testicular cancer patients are at risk to develop low testosterone serum levels and hypogonadism after oncological treatment early in life. The risk for androgen deficiency in healthy men aged 40–60 years is assessed with 7–8%, in testicular cancer patients this risk seems to be three-fold increased (24–26%). Age-adjusted this rate is comparable with the incidence of testosterone deficiency in healthy men in the age group of 60 to 80 years. Anyway, testicular cancer patients may be predisposed for androgen deficiency and should therefore be monitored regularly.