1983 Volume 74 Issue 6 Pages 1023-1043
In order to investigate the effects of anticancer combination therapy and radiotherapy on hypothalamo-pituitary-gonadal axis or adrenocortical function in 65 male urological cancer patients, plasma basal levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (T), adrenocorticotropic hormone (ACTH), cortisol (F), dehydroepiandrosterone (DHA), dehydroepiandrosterone-sulfate (DHA-S) and prolactin (PRL) and LH-releasing hormone (LH-RH) test, clomiphene citrate test and rapid ACTH test were evaluated before and after therapy.
Damage to germinal epithelium was assessed by testicular biopsy or examination of sperm count in testicular tumor patients.
The results were as follows:
1) As to pre-treatment evaluation in patients with urothelial cancer, penile cancer or renal cell carcinoma, significant high plasma levels of LH, FSH associated with significant low plasma levels of T showed the influence of male senescence, but no specific effect of any primary malignancies. By contrast, significant increase in plasma FSH levels with significant decrease of plasma T levels and hypospermatogenesis revealed by testicular biopsy or sperm counting in testicular tumor patients before cancer therapy suggested that contralateral testicular dysfunction had been pre-existing. Pre-treatment DHA concentrations tended to be subnormal with contralateral gonadal dysfunction, suggesting the decline of testicular origin DHA levels in these patients.
2) FSH levels rose significantly after cancer therapy in testicular tumor patients and fall of sperm count or germinal cell damage revealed by testicular biopsy developed further. None of these patients has so far recovered pre-treatment FSH levels or pre-treatment spermatogenesis in a follow up periods of 12 months, whereas LH and T levels did not change throughout radiotherapy or combination chemotherapy.
3) Significantly high levels of FSH (p<0.01) and mild rise in LH levels (p<0.05) with unchanged T levels were demonstrated after combination chemotherapy including radiotherapy in patients with urothelial cancer, penile cancer or renal cell carcinoma, while plasma gonadotropins and T had no change in patients treated with radiotherapy alone. Declining FSH and LH levels to pre-treatment levels seemed to take place 12 months after cessation of cancer therapy.
4) Responses of plasma gonadotropins to LH-RH or responses of gonadotropins and T to clomiphene citrate remained intact before and after cancer therapy. The effects of anticancer combination therapy and radiotherapy on hypothalamo-pituitary-gonadal axis seemed to be primary testicular failure, mainly showing seminiferous tubular damages by cytotoxic action of each therapeutic drugs or by scattered fractionated irradiation to the testis.
5) Plasma F, DHA and DHA-S and responses to synthetic ACTH showed insignificant damage throughout adjuvant chemotherapy or radiotherapy.
6) PRL levels in patients with urological cancer showed no significant change before and after anticancer therapy in the present study.
