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Testicular cancer; gonadal, sexual and psychological aspects of the disease and its treatment.

Eberhard, Jakob LU (2009) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2009:31.
Abstract
The survival rates among testicular germ cell cancer (TGCC) patients have dramatically increased and more than 95 % are cured. The question of quality of life of the survivors is, therefore, important. The TGCC treatment, and thereby its side-effects may vary. A contributing factor to this variation is also genetically determined inter-subject difference in the sensitivity to the adverse effects of cancer therapy. The aim of this thesis has been, in order to improve the management and counselling of TGCC patients, to increase the level of knowledge regarding impairment of reproductive functions as well as the risks of emotional disorders (EMD) related to TGCC and its treatment.

In article I, impact of therapy and androgen receptor... (More)
The survival rates among testicular germ cell cancer (TGCC) patients have dramatically increased and more than 95 % are cured. The question of quality of life of the survivors is, therefore, important. The TGCC treatment, and thereby its side-effects may vary. A contributing factor to this variation is also genetically determined inter-subject difference in the sensitivity to the adverse effects of cancer therapy. The aim of this thesis has been, in order to improve the management and counselling of TGCC patients, to increase the level of knowledge regarding impairment of reproductive functions as well as the risks of emotional disorders (EMD) related to TGCC and its treatment.

In article I, impact of therapy and androgen receptor (AR) polymorphisms on sperm concentration was investigated. Radiotherapy (RT) or 3 to 4 cycles of chemotherapy (SCT) caused initial decline in sperm concentration, which returned to pre-treatment levels 2 to 5 years after therapy. In the SCT group, sperm concentration 1 to 2 years post-treatment was inversely correlated to the androgen receptor (AR) CAG repeat length, indicating a genetic variation in the recovery of sperm concentration. In article II, risk factors for developing hypogonadism were studied. SCT and RT treated were at higher risk of hypogonadism, 6 and 12 months post-treatment as compared to those who received 1 to 2 cycles of chemotherapy. Microlithiasis and hormone deficiency prior to treatment predicted increased risk of hypogonadism after cancer therapy. In article III, TGCC patients, 3 to 5 years after treatment, were compared to the general population concerning prevalence of sexual dysfunctions. A higher proportion of TGCC patients had low sexual desire and erectile dysfunction. Neither hypogonadism nor treatment modality had any obvious impact on the risk of these sexual problems. In article IV, the presence of EMD was investigated, 3 to 5 years after TGCC therapy and related to hypogonadism, AR polymorphisms and treatment modality. Neither anxiety nor depression was overrepresented in hypogonadal TGCC patients and no association between AR polymorphisms and EMD was found. Patients treated with than four cycles of cisplatinum based chemotherapy due to refractory or relapsed disease were more prone to experiencing symptoms of anxiety. (Less)
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author
supervisor
opponent
  • Professor Rörth, Mikael, Department of Oncology, Rigshospitalet, Copenhagen
organization
publishing date
type
Thesis
publication status
published
subject
keywords
depression, sexual dysfunction, hypogonadism, testicular cancer, fertility, anxiety, androgen receptor
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2009:31
pages
168 pages
publisher
Jakob Eberhard, Dep of Clinical Sciences, Malmö University Hospital, Lund University
defense location
Kvinnoklinikens aula, entrance 74, floor 3, Malmö University Hospital
defense date
2009-04-17 09:00
ISSN
1652-8220
ISBN
978-91-86253-18-9
language
English
LU publication?
yes
id
95a60f3b-10d4-4a48-95f0-8f8210686b81 (old id 1363171)
date added to LUP
2009-03-20 09:56:07
date last changed
2016-09-19 08:44:47
@phdthesis{95a60f3b-10d4-4a48-95f0-8f8210686b81,
  abstract     = {The survival rates among testicular germ cell cancer (TGCC) patients have dramatically increased and more than 95 % are cured. The question of quality of life of the survivors is, therefore, important. The TGCC treatment, and thereby its side-effects may vary. A contributing factor to this variation is also genetically determined inter-subject difference in the sensitivity to the adverse effects of cancer therapy. The aim of this thesis has been, in order to improve the management and counselling of TGCC patients, to increase the level of knowledge regarding impairment of reproductive functions as well as the risks of emotional disorders (EMD) related to TGCC and its treatment.<br/><br>
In article I, impact of therapy and androgen receptor (AR) polymorphisms on sperm concentration was investigated. Radiotherapy (RT) or 3 to 4 cycles of chemotherapy (SCT) caused initial decline in sperm concentration, which returned to pre-treatment levels 2 to 5 years after therapy. In the SCT group, sperm concentration 1 to 2 years post-treatment was inversely correlated to the androgen receptor (AR) CAG repeat length, indicating a genetic variation in the recovery of sperm concentration. In article II, risk factors for developing hypogonadism were studied. SCT and RT treated were at higher risk of hypogonadism, 6 and 12 months post-treatment as compared to those who received 1 to 2 cycles of chemotherapy. Microlithiasis and hormone deficiency prior to treatment predicted increased risk of hypogonadism after cancer therapy. In article III, TGCC patients, 3 to 5 years after treatment, were compared to the general population concerning prevalence of sexual dysfunctions. A higher proportion of TGCC patients had low sexual desire and erectile dysfunction. Neither hypogonadism nor treatment modality had any obvious impact on the risk of these sexual problems. In article IV, the presence of EMD was investigated, 3 to 5 years after TGCC therapy and related to hypogonadism, AR polymorphisms and treatment modality. Neither anxiety nor depression was overrepresented in hypogonadal TGCC patients and no association between AR polymorphisms and EMD was found. Patients treated with than four cycles of cisplatinum based chemotherapy due to refractory or relapsed disease were more prone to experiencing symptoms of anxiety.},
  author       = {Eberhard, Jakob},
  isbn         = {978-91-86253-18-9},
  issn         = {1652-8220},
  keyword      = {depression,sexual dysfunction,hypogonadism,testicular cancer,fertility,anxiety,androgen receptor},
  language     = {eng},
  pages        = {168},
  publisher    = {Jakob Eberhard, Dep of Clinical Sciences, Malmö University Hospital, Lund University},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Testicular cancer; gonadal, sexual and psychological aspects of the disease and its treatment.},
  volume       = {2009:31},
  year         = {2009},
}