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Re: Longitudinal Serum Testosterone, Luteinizing Hormone, and Follicle-Stimulating Hormone Levels in a Population-Based Sample of Long-Term Testicular Cancer Survivors
TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPY
542
dynamic contrast images are particularly sensitive to identifying small, abnormal areas of increased enhancement because the prostate cancer recurrence tissue tends to enhance earlier and more intensely than fibrosis or residual benign prostatic tissue. Patients who have undergone radiation therapy and antigen deprivation have global changes in the prostate, which include inflammation, atrophy, fibrosis and overall shrinkage of the gland. These patients have an overall decrease in signal intensity and shrinkage of the peripheral zone, causing complete loss of the normal zonal architecture. The dynamic contrast enhancement images assist in identifying prostate cancer recurrence in the surrounding bed of atrophy and fibrosis due to the early brisk contrast enhancement of the tumor tissue. The apparent diffusion coefficient values of tumor are lower compared to the surrounding benign irradiated tissue, a finding that also may be used to help define residual tumor. This article serves as an excellent review for urologists and radiologists caring for patients with treated prostate cancer with a clinical suspicion of recurrence. As techniques for prostate sparing therapy become more integrated, imaging of these patients will increase. Cary Siegel, MD
Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: Longitudinal Serum Testosterone, Luteinizing Hormone, and Follicle-Stimulating Hormone Levels in a Population-Based Sample of Long-Term Testicular Cancer Survivors M. Sprauten, M. Brydøy, H. S. Haugnes, M. Cvancarova, T. Bjøro, J. Bjerner, S. D. Fossa˚ and J. Oldenburg Oslo University Hospital, University of Oslo and F€ u rst Medical Laboratory, Oslo, University of Bergen, Bergen, and University of Tromsø and University Hospital of North Norway, Tromsø, Norway J Clin Oncol 2014; 32: 571e578.
Abstract available at http://jurology.com/ Editorial Comment: Because the majority of patients with testicular cancer are cured following treatment and are expected to live for long periods, issues about long-term toxicities are especially important. Since all treatments affect endocrine and exocrine hypogonadism, the authors evaluated blood samples before orchiectomy and at 9 and 18 years after treatment for 307 patients with testicular cancer. The risks of lower testosterone and higher luteinizing hormone (LH) and follicle-stimulating hormone levels were significantly increased at all points after radiation therapy or chemotherapy. Odds ratio for lowest testosterone at age 18 was 3.3. Odds ratio for lower testosterone was 3.3 at 9 years and 5.2 at 18 years for the radiation therapy and chemotherapy groups. Odds ratios for increased LH and follicle-stimulating hormone were 4.4 at 9 years and 18.9 at 18 years for the radiation therapy group, and 3.6 at 9 years and 14.2 at 18 years for the chemotherapy group. Interestingly the cumulative platinum dose was significantly associated with risk of increased LH levels. The authors conclude that long-term testicular cancer survivors are at risk for premature hormonal aging. Jerome P. Richie, MD
542
dynamic contrast images are particularly sensitive to identifying small, abnormal areas of increased enhancement because the prostate cancer recurrence tissue tends to enhance earlier and more intensely than fibrosis or residual benign prostatic tissue. Patients who have undergone radiation therapy and antigen deprivation have global changes in the prostate, which include inflammation, atrophy, fibrosis and overall shrinkage of the gland. These patients have an overall decrease in signal intensity and shrinkage of the peripheral zone, causing complete loss of the normal zonal architecture. The dynamic contrast enhancement images assist in identifying prostate cancer recurrence in the surrounding bed of atrophy and fibrosis due to the early brisk contrast enhancement of the tumor tissue. The apparent diffusion coefficient values of tumor are lower compared to the surrounding benign irradiated tissue, a finding that also may be used to help define residual tumor. This article serves as an excellent review for urologists and radiologists caring for patients with treated prostate cancer with a clinical suspicion of recurrence. As techniques for prostate sparing therapy become more integrated, imaging of these patients will increase. Cary Siegel, MD
Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: Longitudinal Serum Testosterone, Luteinizing Hormone, and Follicle-Stimulating Hormone Levels in a Population-Based Sample of Long-Term Testicular Cancer Survivors M. Sprauten, M. Brydøy, H. S. Haugnes, M. Cvancarova, T. Bjøro, J. Bjerner, S. D. Fossa˚ and J. Oldenburg Oslo University Hospital, University of Oslo and F€ u rst Medical Laboratory, Oslo, University of Bergen, Bergen, and University of Tromsø and University Hospital of North Norway, Tromsø, Norway J Clin Oncol 2014; 32: 571e578.
Abstract available at http://jurology.com/ Editorial Comment: Because the majority of patients with testicular cancer are cured following treatment and are expected to live for long periods, issues about long-term toxicities are especially important. Since all treatments affect endocrine and exocrine hypogonadism, the authors evaluated blood samples before orchiectomy and at 9 and 18 years after treatment for 307 patients with testicular cancer. The risks of lower testosterone and higher luteinizing hormone (LH) and follicle-stimulating hormone levels were significantly increased at all points after radiation therapy or chemotherapy. Odds ratio for lowest testosterone at age 18 was 3.3. Odds ratio for lower testosterone was 3.3 at 9 years and 5.2 at 18 years for the radiation therapy and chemotherapy groups. Odds ratios for increased LH and follicle-stimulating hormone were 4.4 at 9 years and 18.9 at 18 years for the radiation therapy group, and 3.6 at 9 years and 14.2 at 18 years for the chemotherapy group. Interestingly the cumulative platinum dose was significantly associated with risk of increased LH levels. The authors conclude that long-term testicular cancer survivors are at risk for premature hormonal aging. Jerome P. Richie, MD