|The following article features coverage from the American Urological Association (AUA) 2019 meeting. Click here to read more of Renal & Urology News’ conference coverage.|
CHICAGO—Perioperative hypogonadism is prevalent and persistent in men undergoing radical cystectomy (RC) for non-metastatic bladder cancer, according to new study findings presented at the 2019 American Urological Association annual meeting.
A team led by Woodson Smelser, MD, of the University of Kansas Medical Center in Kansas City, prospectively enrolled 25 male RC patients (mean age 69 years) with no history of hypogonadism treatment. Before surgery, mean total testosterone (TT) was within the normal range at 308 ng/dL, but 12 patients had low testosterone and 3 had low luteinizing hormone. Shortly after surgery, mean TT fell to 166 ng/dL, and hypogonadism developed in 7 previously eugonadal patients. At day 30, mean TT was still below normal at 253 ng/dL and 19 of the 25 patients were considered hypogonadal.
Hypogonadism prevalence preoperatively, immediately postoperatively, and at 30 days and 90 days postoperatively was 52.5%, 95%, 63%, and 37.5% respectively.
“In our study, many men who were not hypogonadal before surgery migrated and stayed in a hypogonadal state for more than 30 days,” Dr Smelser told Renal & Urology News. “Furthermore, hypogonadism persisted out to 90 days or more in greater than one third of our trial cohort. This represents a more prolonged period of hypogonadism than has been classically described in the surgical, burn, and critical care literature.”
Most men experienced significant mean weight loss over the same period. Mean weight loss from baseline to 90 days postoperatively was 5.92 and 6.86 kg for hypogonadal men with pre-operative TT less than 100 ng/dL and 100 to 300 ng/dL, respectively. Eugonadal patients lost just 2.46 kg.
“Men who began the trial hypogonadal per the laboratory definition set forth in the AUA Guidelines on Management of Testosterone Deficiency experienced a 2-fold greater mean weight loss than those who began the trial in a eugonadal state,” Dr Smelser said. “Given the well-established complications surrounding cachexia in the radical cystectomy patient population, this study provides new insights. Treatment of perioperative hypogonadism may represent a potential therapeutic intervention to reduce the post-operative morbidity of radical cystectomy.”
The investigators have started a phase 2 randomized controlled trial to see whether correcting perioperative hypogonadism improves the health of RC patients.
Read more of Renal & Urology News’ coverage of the AUA 2019 meeting by visiting the conference page.
Smelser W, Lee E, Nangia A, Glavin K, and Holzbeierlein J. Perioperative hypogonadism in men undergoing radical cystoprostatectomy for bladder cancer. Presented at the 2019 American Urological Association annual meeting held May 3-6 in Chicago. Abstract MP05-01.