Long term deficiency of vitamin D in germ cell testicular cancer survivors
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Lucia Nappi1, Margaret Ottaviano2, Pasquale Rescigno2,3, Ladan Fazli1, Martin E. Gleave1, Vincenzo Damiano2, Sabino De Placido4 and Giovannella Palmieri2
1Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
2Department of Medicine and Surgery, Division of Medical Oncology, Centro di Riferimento Tumori Rari Regione Campania, University of Naples “Federico II”, Napoli, Italy
3The Institute of Cancer Research, Prostate Targeted Therapy Group, Sutton, UK
4Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
Giovannella Palmieri, email: email@example.com
Keywords: testicular cancer; vitamin D; testicular cancer survivors; long term side effects; quality of life
Received: August 06, 2017 Accepted: December 05, 2017 Published: April 20, 2018
Background: Cisplatin-based chemotherapy significantly improved the survival of patients with germ cell testicular cancer. However, long term side effects of chemotherapy have non-negligible impact on the quality of life of these young patients, who have a long life expectancy after being successfully treated.
Materials and Methods: 25-OH vitamin D, testosterone, FSH and LH of patients with testicular cancer were retrospectively evaluated and for each patient clinical information were collected. The tissue of 52 patients with germ cell tumors was analyzed for VDR expression by immunohistochemistry. The serum 25-OH vitamin D and VDR expression were correlated to the patients ‘clinical characteristics.
Results: 25-OH vitamin D was analyzed in 82 patients. Insufficient (< 30 ng/ml) levels were detected in 65%–85%, mild deficient (< 20 ng/ml) in 25%–36% and severe deficient (< 10 ng/ml) in 6%–18% of the patients over a median follow-up of 48 months. No difference in serum 25-OH vitamin D was detected over the follow-up time points. No correlation with histology, stage and type of treatment was found. The 25-OH vitamin D levels were not correlated to testosterone, FSH and LH levels. Interestingly, the expression of VDR was much higher in non seminoma than in seminoma tissue.
Conclusions: Patients with testicular cancer have reduced vitamin D levels after the treatment of the primary cancer. Since long term hypovitaminosis D leads to high risk of fractures, infertility and cardiovascular diseases, we envision that vitamin D should be regularly checked in patients with testicular cancer and replaced if needed.
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