It is my pleasure to stand here today and present on behalf of my colleagues in the PLATINUM study some of our findings of this study of testicular cancer survivors with a focus on hypogonadism and associated adverse health outcomes.
Testicular cancer is the most common cancer in young men; today 95% of all testicular cancer patients are cured of their disease thanks to cisplatin based chemotherapy that Dr Lawrence Einhorn discovered in 1974 that the addition of cisplatin to the treatment regimen back then achieved a significant improvement in the cure of this disease. Nowadays testicular cancer survivors can expect to live for over forty years from the time of their diagnosis. However, they are at risk of other health problems that may be related to their cancer treatment including late complications from chemotherapy. The PLATINUM study is an ongoing multicentre study of North American testicular cancer survivors, obviously its name stems from cisplatin and the aim of the study is to investigate the major health problems in testicular cancer survivors and understand how and why they develop with the goal of preventing them and minimising the burden of cure.
Today I will be presenting an analysis from the PLATINUM study looking at the problem of hypogonadism or low testosterone levels. Men with hypogonadism may suffer from decreased energy, depressed mood, decreased sexual desire and performance as well as night sweats. Hypogonadism is also a major risk factor for metabolic syndrome which is a cause of cardiac disease.
Our goal is to identify clinical and genetic factors that may help us better predict which survivors are at increased risk of developing hypogonadism. Hypogonadism is defined in this study as a total serum testosterone level below 3ng/ml or the use of testosterone replacement therapy. We also want to see if the survivors with hypogonadism are more likely to have other medical problems associated with it.
This analysis includes the first 491 survivors participating in the PLATINUM study. All participants received platinum based chemotherapy; they completed comprehensive and validated questionnaires and underwent a brief physical examination. They provided blood samples and their testosterone levels were measured. They also had their DNA analysed. Of the 491 survivors evaluated in this study 38% had low testosterone levels or were taking testosterone replacement therapy. Please keep in mind that the majority of these survivors are still young with an average age of 38 years. Older survivors were at higher risk for hypogonadism, as shown in this figure. In addition, survivors who were overweight or obese were more likely to have lower testosterone levels. Genetic variations in the sex-hormone binding globulin gene appeared important in defining the risk for hypogonadism, however, this finding needs to be confirmed in larger studies including the next phase of the PLATINUM study.
We investigated the association between hypogonadism and fifteen different medical conditions. We found that testicular cancer survivors with low testosterone levels, when compared to survivors with normal levels, were at least three times more likely to have high cholesterol, almost twice more likely to take medications for hypertension, erectile dysfunction or diabetes. They were also more likely to take medications for anxiety or depression.
To summarise, testicular cancer survivors, especially those treated with chemotherapy, are at increased risk for hypogonadism, a problem that can be associated with predisposing factors for heart disease. Increasing age and weight are associated with lower testosterone levels and genetic factors also appear of importance in cancer survivors and their role needs further investigation.
In conclusion, there will always be the potential for late complications from curative platinum chemotherapy. Mitigating approaches are the usual weight control, exercise and monitoring blood pressure and cholesterol levels. We will never omit cisplatin from the treatment regimen to prevent complications but recognising and treating symptomatic hypogonadism can improve quality of life and lessen adverse health outcomes, especially those related to metabolic syndrome and resulting diabetes, hyperlipidemia, and early cardiac problems.
I would like to take this opportunity to thank the National Cancer Institute for their sponsorship of the study and all the survivors participating in this study. Thank you.
