Long-term follow-up of testicular cancer patients shows no predisposition to osteoporosis

Murugaesu, Nirupa; Powles, Thomas; Bestwick, J.; Oliver, R. T. D.; Shamash, Jonathan

doi:10.1007/s00198-008-0793-x

Cited by 11 publications

(33 citation statements)

References 9 publications

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“…Accordingly, the 9-year-long follow-up in 91 testicular tumor survivors (mean age: 31 years) revealed a significantly 6–8% lower hip BMD in both untreated and treated hypogonadal survivors compared to eugonodal ones and a significant 8% lower spinal BMD in untreated hypogonadal compared to eugonodal survivors (40), thus suggesting the increased risk of impaired bone health in hypogonadal testicular tumor survivors. By contrast, a single study on only 39 testicular tumor (TT) patients after a follow-up time ranging from 5 to 28 years did not find abnormal BMD in patients treated with surgery alone or with chemotherapy (41). Summary of available data from studies on bone mineralization in testicular cancer survivors is described in Table 4.…”

Section: Hypogonadismmentioning

confidence: 87%

Hypogonadism and Sexual Dysfunction in Testicular Tumor Survivors: A Systematic Review

et al. 2019

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Testicular tumor is the most common malignancy in men of reproductive age. According to the tumor histology and staging, current treatment options include orchiectomy alone or associated with adjuvant chemo- and/or radiotherapy. Although these treatments have considerably raised the percentage of survivors compared to the past, they have been identified as risk factors for testosterone deficiency and sexual dysfunction in this subgroup of men. Male hypogonadism, in turn, predisposes to the development of metabolic and cardiovascular impairment that negatively affects general health. Accordingly, longitudinal studies report a long-term risk for cardiovascular diseases after radiotherapy and/or cisplatin-based chemotherapy in testicular tumor survivors. The aim of this review was to summarize the current evidence on hypogonadism and sexual dysfunction in long-term cancer survivors, including the epidemiology of cardiovascular and metabolic disorders, to increase the awareness that serum testosterone levels, sexual function, and general health should be evaluated during the endocrinological management of these patients.

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Section: Hypogonadismmentioning

confidence: 87%

Hypogonadism and Sexual Dysfunction in Testicular Tumor Survivors: A Systematic Review

et al. 2019

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“…Also the study by Foresta et al (2013) showed lower BMD in TCS as compared to controls, despite no biochemical signs of testosterone deficiency in the patient group. Another follow-up study (Willemse et al, 2010) reported TCS to have increased prevalence of mild to moderate vertebral fractures, with no association to BMD and the treatment given whereas Murugaesu et al (2009) found no increased risk of osteoporosis in this patient group. Finally, Ondrusova et al recently reported 43-51% of TCS presenting with osteopenia/osteoporosis (T-/Z-score <À1).…”

Section: Introductionmentioning

confidence: 74%

“…However, this study was based on a slightly smaller number of patients, no controls were included and the association between treatment and BMD was not adjusted for hypogonadism. Another study, (Murugaesu et al, 2009) based on 39 TCS, found no increased risk of osteoporosis after a follow-up of 5-28 years. No separate assessment for those having testosterone deficiency was done, why the general conclusion of the study is in agreement with our findings for the total group of TCS and also with an earlier report (Stutz et al, 1998) including 30 stage I seminoma patients.…”

Section: Discussionmentioning

confidence: 95%

Risk of low bone mineral density in testicular germ cell cancer survivors: association with hypogonadism and treatment modality

et al. 2017

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The cure rate of testicular cancer exceeds 95%, but testicular cancer survivors (TCS) are at increased risk of hypogonadism (HG). It has been suggested that TCS have reduced bone mineral density (BMD), but it is unclear whether this is related to HG or a direct effect of cancer therapy. The aim of this study was to evaluate whether TCS have decreased BMD, and if BMD is related to HG and/or the cancer treatment given. We investigated 91 TCS (mean age at diagnosis: 31 years; mean 9.3 years follow-up) and equal number of age matched controls (mean age at inclusion 40.3 years and 41.2 years, respectively). Total testosterone and LH were measured. BMD was determined using dual-energy X-ray absorptiometry (DXA). Low BMD (LBD) was defined as Z-score <-1. Compared to eugonadal TCS, both TCS with untreated HG (mean difference: -0.063 g/cm ; 95% CI: -0.122; -0.004 p = 0.037) and TCS receiving androgen replacement (mean difference -0.085 g/cm ; 95% CI: -0.168; -0.003; p = 0.043) presented with statistically significantly 6-8% lower hip BMD. At the spine, L1-L4, an 8% difference reached the level of statistical significance only for those with untreated HG (mean difference: -0.097 g/cm ; 95% CI: -0.179; -0.014; p = 0.022). TCS with untreated HG had significantly increased OR for spine L1-L4 LBD (OR = 4.1; 95% CI: 1.3; 13; p = 0.020). The associations between the treatment given and BMD were statistically non-significant, both with and without adjustment for HG. In conclusion, TCS with HG are at increased risk of impaired bone health. Prevention of osteoporosis should be considered as an important part in future follow up of these men.

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“…Damage of gonadal function and subnormal levels of TST were described not only in patients, following chemotherapy or radiotherapy, but also in subjects who are long-term survivors following orchiectomy alone. No significant differences were found in hormonal levels of TST and LH between the chemotherapy and surveillance (orchiectomy alone) groups [15]. Lackner et al [16] detected hypogonadism and androgen deficiency symptoms in 26.5% of patients after testicular cancer treatment, irrespective of the treatment strategy.…”

Section: Discussionmentioning

confidence: 96%

“…These discrepancies might be due to differences in the chemotherapy regimen used, doses and also the lenght of follow-up [12]. Analysis of Murugaesu et al showed no evidence in association between cases of osteopenia and lenght of follow-up [15].…”

Section: Discussionmentioning

confidence: 99%

Damage of hormonal function and bone metabolism in long-term survivors of testicular cancer

Ondrušová

Ondruš²,

Dušek³

et al. 2009

neo

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Improved survival of testicular cancer (TC) patients leads to rising of interest on the disease consequences for the whole organism (impact on hormonal status, bone metabolism). The aim of the study was to present three years experience with hormonal and osteologic examination in long-term survivors of TC. During the period of 11/2005-1/2009 879 patients who were previously treated for TC (823 with unilateral, 56 with bilateral disease) were examined. Each patient underwent hormonal and osteologic examination, results of which were associated with therapy following orchiectomy and with the time interval since the primary therapy. The median follow-up time in patients with unilateral TC was 96 months since the therapy. Mean age at the time of examination was 32 years. Testosterone deficiency was observed in 171 patients (19.5%), increased LH in 168 patients (19.1%), increased S-CTx in 388 patients (44.1%). Bone damage (osteopenia and/or osteoporosis) was observed in 445 patients (50.6%). The median follow-up time in patients with bilateral TC was 175 months. Mean age at the time of examination was 27 years. Testosterone deficiency was observed in 47 patients (83.9%), increased LH in 45 patients (80.4%), increased S-CTx in 31 patients (55.4%). Bone damage was observed in 41 patients (73.2%). Hormonal examination and testosterone substitution may be recommended as an important aspect of patient´s follow-up in bilateral TC, moreover in unilateral disease. The important part of standard examination algorithm should be also osteological examination to prevent osteopenia or even osteoporosis development.

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Long-term follow-up of testicular cancer patients shows no predisposition to osteoporosis

Abstract: This work found no association between treatment for testis cancer and the development of osteoporosis. Screening the whole population of testis cancer survivors for osteoporosis in the long term is not necessary; however, targeting specific patients with risk factors may be warranted.

Cited by 11 publications

References 9 publications

Hypogonadism and Sexual Dysfunction in Testicular Tumor Survivors: A Systematic Review

Hypogonadism and Sexual Dysfunction in Testicular Tumor Survivors: A Systematic Review

Risk of low bone mineral density in testicular germ cell cancer survivors: association with hypogonadism and treatment modality

Damage of hormonal function and bone metabolism in long-term survivors of testicular cancer

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