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Pape J, Fernando J, Megaritis D, Weidlinger S, Vidal A, Birkhäuser FD, Karrer T, von Wolff M. Oncological treatments have limited effects on the fertility prognosis in testicular cancer: A systematic review and meta-analysis. Andrology 2024. [PMID: 39189883 DOI: 10.1111/andr.13741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/03/2024] [Accepted: 08/10/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Testicular cancer is the most common solid tumour among young men in the reproductive phase. After completing cancer treatment, up to 77% of cancer survivors report an interest in paternity after completing cancer treatment. To preserve fertility, most guidelines recommend that physicians should counsel their patients about sperm cryopreservation before initiating gonadotoxic therapy. However, few studies have assessed fertility parameters after testicular cancer therapies over the last 20 years. OBJECTIVES To close the gap of data regarding gonadotoxicity of testicular cancer therapies to enable more accurate counselling regarding fertility preservation. MATERIALS AND METHODS A systematic literature search was conducted in Medline, Embase and Cochrane until December 2022. The systematic review included studies of men who had undergone all types of unilateral testicular cancer treatment, whereas the meta-analysis excluded studies with unspecified treatments, less than 10 patients for outcome evaluation or rare tumours. Infertility (i.e. azoospermia, failure to achieve paternity or the usage of cryosperm) was defined as outcome. RESULTS The qualitative analysis included 30 studies with a total of 13,718 men after unilateral testicular cancer. Treatment comprised active surveillance after unilateral orchidectomy (32.7%), radiotherapy (23.1%), standard- or low-dose chemotherapy (33.7%) and high-dose chemotherapy (1.4%). Post-treatment spermiograms were analysed in 17 studies. The quantitative synthesis included 23 studies, revealing an overall pooled prevalence of infertility (95% CI) of 14% (9%-21%). Azoospermia occurred in 8% (6%-12%). For good-prognosis patients who received standard therapy, the overall prevalence of infertility was only 4% (2%-10%). CONCLUSION So far, this very first meta-analysis of overall infertility prevalence provides the best approximation of fertility prognosis for men who have undergone testicular cancer therapy. Despite the low prevalence of infertility, it is still recommended to undergo sperm cryopreservation because of the uncertainty of the subsequent therapy and the lack of large longitudinal data on individual treatment effects.
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Affiliation(s)
- Janna Pape
- Division of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, Inselspital Bern, University of Bern, Bern, Switzerland
| | | | - Dimitrios Megaritis
- Division of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Susanna Weidlinger
- Division of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Angela Vidal
- Division of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, Inselspital Bern, University of Bern, Bern, Switzerland
| | | | - Tanya Karrer
- Medical Library, University Library Bern, University of Bern, Bern, Switzerland
| | - Michael von Wolff
- Division of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, Inselspital Bern, University of Bern, Bern, Switzerland
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Raffo M, Di Naro A, Napolitano L, Aveta A, Cilio S, Pandolfo SD, Manfredi C, Lonati C, Suardi NR. Testicular Cancer Treatments and Sexuality: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:586. [PMID: 38674232 PMCID: PMC11051825 DOI: 10.3390/medicina60040586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
The incidence of testicular cancer (TC) has been rapidly increasing over the past years. Diagnosis and early treatment have shown good oncological control, guaranteeing the patient different treatment approaches according to histology and tumor stage. Currently, physicians usually prioritize oncological outcomes over sexual outcomes and quality of life, considering as a first aim the overall survival of the patients; however, differently from other neoplasms, quality of life is still strongly affected among TC patients, and sexual outcomes are frequently compromised after each TC treatment. Several studies have suggested that each treatment approach may be associated with sexual dysfunctions, including erectile dysfunction, ejaculatory disorders, fertility issues, and hormonal changes. Since testicular cancer patients are more frequently young men, the subject of this work is substantial and should be analyzed in detail to help specialists in the management of this disease. The aim of the current narrative review is to generally describe every treatment for TC, including surgery, chemotherapy, radiotherapy, and retroperitoneal lymph node dissection, and to establish which sexual dysfunction may be specifically associated with each therapy.
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Affiliation(s)
- Massimiliano Raffo
- Department of Urology, Spedali Civili Brescia, 25123 Brescia, Italy; (C.L.); (N.R.S.)
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Angelo Di Naro
- Department of Urology, Spedali Civili Brescia, 25123 Brescia, Italy; (C.L.); (N.R.S.)
| | - Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Achille Aveta
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Simone Cilio
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80138 Naples, Italy; (L.N.); (A.A.); (S.C.); (S.D.P.)
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University, 80138 Naples, Italy;
| | - Chiara Lonati
- Department of Urology, Spedali Civili Brescia, 25123 Brescia, Italy; (C.L.); (N.R.S.)
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3
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McHugh DJ, Gleeson JP, Feldman DR. Testicular cancer in 2023: Current status and recent progress. CA Cancer J Clin 2024; 74:167-186. [PMID: 37947355 DOI: 10.3322/caac.21819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023] Open
Abstract
Testicular germ cell tumor (GCT) is the most common solid tumor in adolescent and young adult men. Progress in the management of GCT has been made in the last 50 years, with a substantial improvement in cure rates for advanced disease, from 25% in the 1970s to nearly 80%. However, relapsed or platinum-refractory disease occurs in a proportion, 20% of whom will die from disease progression. This article reviews the current evidence-based treatments for extracranial GCT, the acute and chronic toxic effects that may result, and highlights contemporary advances and progress in the field.
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Affiliation(s)
- Deaglan J McHugh
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Jack P Gleeson
- Cancer Research, College of Medicine and Health, University College Cork, Cork, Ireland
- Medical Oncology Department, Cork University Hospital, Cork, Ireland
| | - Darren R Feldman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
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4
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Zheng Y, Li DM, Li FP, Jiang XH, Yang L, Qu R, Bai HZ, Zhao GC, Tian K. Case report: remedial microdissection testicular sperm extraction after onco-microdissection testicular sperm extraction failure. Medicine (Baltimore) 2024; 103:e37201. [PMID: 38394502 PMCID: PMC11309596 DOI: 10.1097/md.0000000000037201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Testicular cancer (TC) mostly occurs in men aged 14 to 44. Studies have shown that TC seriously damages male fertility, and 6% to 24% of patients with TC were even found to suffer from azoospermia when they are diagnosed. At present, some studies have pointed out that onco-microdissection testicular sperm extraction (mTESE) can extract sperm from tumor testicles. However, there are almost no reports on remedial measures after onco-mTESE failure. Given the valuable opportunity for fertility preservation in patients with TC and azoospermia, it is necessary to provide effective remedial methods for patients with failed onco-mTESE. METHODS Two young men, who were diagnosed with TC and also found to have azoospermia, tried onco-mTESE while undergoing radical orchiectomy for fertility preservation. However, sperm extraction failed in both patients. Subsequently, the isolated testicular tissue of the patient in case 1 suffered from TC again, and the patient in case 2 was scheduled to receive multiple cycles of gonadotoxic chemotherapy. Because both had a plan to have a birth in the future, we performed remedial mTESE. RESULTS Sperm was successfully extracted from both patients. The patient recovered well, without complications. The patient couple in case 1 underwent 1 intracytoplasmic sperm injection (ICSI) cycle but did not achieve clinical pregnancy. CONCLUSIONS There is still an opportunity to extract sperm successfully using onco-mTESE, despite the difficulty of fertility preservation in TC patients with azoospermia. If sperm extraction from the tumor testis fails, implementing remedial mTESE as early as possible would likely preserve the last chance of fertility for these patients.
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Affiliation(s)
- Yi Zheng
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Ding-Ming Li
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Fu-Ping Li
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Xiao-Hui Jiang
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Luo Yang
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, China
| | - Rui Qu
- Department of Urology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, China
| | - Heng-Zhou Bai
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Gui-Cheng Zhao
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
| | - Kun Tian
- Human Sperm Bank, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Department of Andrology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China
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Moradi M, Hashemian MA, Faramarzi A, Goodarzi N, Hashemian AH, Cheraghi H, Jalili C. Therapeutic effect of sodium alginate on bleomycin, etoposide and cisplatin (BEP)-induced reproductive toxicity by inhibiting nitro-oxidative stress, inflammation and apoptosis. Sci Rep 2024; 14:1565. [PMID: 38238398 PMCID: PMC10796429 DOI: 10.1038/s41598-024-52010-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024] Open
Abstract
Impaired spermatogenesis and male infertility are common consequences of chemotherapy drugs used in patients with testicular cancer. The present study investigated the effects of sodium alginate (NaAL) on testicular toxicity caused by bleomycin, etoposide, and cisplatin (BEP). Rats in group 1 received normal saline, while groups 2 and 3 were treated with 25 and 50 mg/kg of NaAL, respectively. Group 4 was treated with a 21-day cycle of BEP (0.5 mg/kg bleomycin, 5 mg/kg etoposide, and 1 mg/kg cisplatin), and groups 5 and 6 received BEP regimen plus 25 and 50 mg/kg of NaAL, respectively. Then, sperm parameters, testosterone levels, testicular histopathology and stereological parameters, testicular levels of malondialdehyde (MDA), nitric oxide (NO), and total antioxidant capacity (TAC), and the expression of apoptosis-associated genes including Bcl2, Bax, Caspase3, p53, and TNF-α were evaluated. Our findings revealed that NaAL improved sperm parameters, testosterone levels, histopathology, and stereology parameters in BEP-administrated rats. NaAL also improved testis antioxidant status by enhancing TAC and ameliorating MDA and NO. Further, modifications to the expression of Bcl2, Bax, Caspase3, p53, and TNF-α suggested that NaAL alleviated BEP-induced apoptosis and inflammation. Collectively, NaAL protects rats' testes against BEP-evoked toxicity damage through the modulation of nitro-oxidative stress, apoptosis, and inflammation.
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Affiliation(s)
- Mojtaba Moradi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Razi University, Kermanshah, Iran
- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Azita Faramarzi
- Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Nader Goodarzi
- Department of Basic and Pathobiological Sciences, Faculty of Veterinary Medicine, Razi Universtiy, Kermanshah, Iran.
| | - Amir Hossein Hashemian
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hadi Cheraghi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Razi University, Kermanshah, Iran
| | - Cyrus Jalili
- Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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6
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Wood GE, Chamberlain F, Tran B, Conduit C, Liow E, Nicol DL, Shamash J, Alifrangis C, Rajan P. Treatment de-escalation for stage II seminoma. Nat Rev Urol 2023:10.1038/s41585-023-00727-0. [PMID: 36882564 DOI: 10.1038/s41585-023-00727-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/09/2023]
Abstract
International Germ Cell Cancer Collaborative Group good-risk metastatic seminoma has cure rates of >95%. Within this risk group, patients with stage II disease exhibit the best oncological outcomes with the standard-of-care treatment strategies of radiotherapy or combination chemotherapy. However, these treatments can be associated with substantial early and late toxic effects. Therapy de-escalation aims to reduce treatment morbidity whilst preserving oncological outcomes. The evidence supporting such approaches is largely from non-randomized institutional data, and therefore this strategy is not recognized as standard of care. Current de-escalation approaches for stage II seminoma include single-agent chemotherapy, radiotherapy and surgery based on early data from clinical studies. Increased recognition of emerging data on treatment modification to reduce morbidity whilst maintaining cure rates and consideration of therapy de-escalation could improve patient survivorship outcomes.
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Affiliation(s)
- Georgina E Wood
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Medical Oncology, Barts Health NHS Trust, London, UK
| | | | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Ciara Conduit
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Elizabeth Liow
- Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - David L Nicol
- Department of Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Jonathan Shamash
- Department of Medical Oncology, Barts Health NHS Trust, London, UK
| | - Constantine Alifrangis
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK. .,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Prabhakar Rajan
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, UK. .,Division of Surgery and Interventional Science, University College London, London, UK. .,Department of Urology, Barts Health NHS Trust, London, UK. .,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
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7
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Linagliptin and Vitamin D3 Synergistically Rescue Testicular Steroidogenesis and Spermatogenesis in Cisplatin-Exposed Rats: The Crosstalk of Endoplasmic Reticulum Stress with NF-κB/iNOS Activation. Molecules 2022; 27:molecules27217299. [DOI: 10.3390/molecules27217299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/16/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
This study investigated the therapeutic effect of linagliptin and/or vitamin D3 on testicular steroidogenesis and spermatogenesis in cisplatin-exposed rats including their impact on endoplasmic reticulum (ER) stress and NF-κB/iNOS crosstalk. Cisplatin (7 mg/kg, IP) was injected into adult male albino rats which then were orally treated with drug vehicle, linagliptin (3 mg/kg/day), vitamin D3 (10 μg/kg/day) or both drugs for four weeks. Age-matched rats were used as the control group. Serum samples and testes were collected for further analyses. Cisplatin induced testicular weight loss, deteriorated testicular architecture, loss of germ cells and declined serum and intra-testicular testosterone levels, compared to the control group. There was down-regulation of steroidogenic markers including StAR, CYP11A1, HSD3b and HSD17b in cisplatin-exposed rats, compared with controls. Cisplatin-exposed rats showed up-regulation of ER stress markers in testicular tissue along with increased expression of NF-κB and iNOS in spermatogenic and Leydig cells. These perturbations were almost reversed by vitamin D3 or linagliptin. The combined therapy exerted a more remarkable effect on testicular dysfunction than either monotherapy. These findings suggest a novel therapeutic application for linagliptin combined with vitamin D3 to restore testicular architecture, aberrant steroidogenesis and spermatogenesis after cisplatin exposure. These effects may be attributed to suppression of ER stress and NF-kB/iNOS.
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Bimbatti D, Lai E, Pierantoni F, Maruzzo M, Msaki A, De Toni C, Dionese M, Feltrin A, Basso U, Zagonel V. Patient Reported Outcomes, Paternity, Relationship, and Fertility in Testicular Cancer Survivors: Results from a Prospective Observational Single Institution Trial. Patient Prefer Adherence 2022; 16:3393-3403. [PMID: 36582267 PMCID: PMC9793790 DOI: 10.2147/ppa.s381812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/29/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Testicular cancer (TC) is the most common solid tumor in young adults. 95% of patients are cured, but they may experience late adverse effects (anxiety, fear of recurrence, and sexual dysfunction) with an impact on daily life. We attempted to assess Patient Reported Outcomes (PROMs), long-term sexual disorders, and difficulties in achieving fatherhood in a cohort of TC survivors, as well as their possible correlation with previous cancer treatments. METHODS Different questionnaires, such as the Impact of Cancer (IOC) and the Body Image Scale (BIS), were used to investigate the distinct areas of the PROMs. International Index of Erectile Function (IIEF15) and the Premature Ejaculation Diagnostic Tool (PEDT) focused on sexuality and fertility. Patients were prospectively recruited between February 2020 and February 2022. RESULTS 144 participants completed all the questionnaires. Results showed a good QoL, a moderate fear of TC recurrence, a good satisfaction with their personal body image, low incidence of premature ejaculation and erectile dysfunction. 19.5% of patients who had a testicular implant reported general dissatisfaction. Only 18% of patients had unsuccessfully attempted fatherhood, while the majority had not yet tried, and 23.4% succeeded. A low percentage of patients used procedures assisted reproduction and adoption. CONCLUSION This trial supports the use of various questionnaires as a multifactorial tool capable of investigating all the aspects of long-term cancer survivorship. The assessment of medical and psychosocial sequelae is an essential part of patient care and is important for the development of a comprehensive care plan for TC survivors.
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Affiliation(s)
- Davide Bimbatti
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
- Correspondence: Davide Bimbatti, Oncology 1 Unit, Istituto Oncologico Veneto, IOV - IRCCS, via Gattamelata 64, Padova, 35128, Italy, Email
| | - Eleonora Lai
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Francesco Pierantoni
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
- Oncology 3 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
| | - Marco Maruzzo
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
| | - Aichi Msaki
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
| | - Chiara De Toni
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
| | - Michele Dionese
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Alessandra Feltrin
- Hospital Psychology Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
| | - Umberto Basso
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Oncology 1 Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
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9
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Liu W, Zhang L, Gao A, Khawar MB, Gao F, Li W. Food-Derived High Arginine Peptides Promote Spermatogenesis Recovery in Busulfan Treated Mice. Front Cell Dev Biol 2021; 9:791471. [PMID: 34993200 PMCID: PMC8724571 DOI: 10.3389/fcell.2021.791471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022] Open
Abstract
Food-derived peptides with high arginine content have important applications in medicine and food industries, but their potential application in the treatment of oligoasthenospermia remains elusive. Here, we report that high-arginine peptides, such as Oyster peptides and Perilla purple peptides were able to promote spermatogenesis recovery in busulfan-treated mice. We found that both Opp and Ppp could increase sperm concentration and motility after busulfan-induced testicular damage in mice. Further research revealed that Opp and Ppp might promote spermatogonia proliferation, which improved blood-testis barrier recovery between Sertoli cells. Taken together, these high-arginine peptides might be used as a medication or therapeutic component of a diet prescription to improve the fertility of some oligoasthenospermia patients.
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Affiliation(s)
- Wenwen Liu
- College of Life Sciences, University of Science and Technology of China, Hefei, China
- Institute of Reproductive Health and Perinatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lingfeng Zhang
- Institute of Reproductive Health and Perinatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
| | - Anning Gao
- College of Biology and Food, Shangqiu Normal University, Shangqiu, China
| | - Muhammad Babar Khawar
- Molecular Medicine and Cancer Therapeutics Lab, Department of Zoology, Faculty of Sciences, University of Central Punjab, Lahore, Pakistan
| | - Fengyi Gao
- College of Biology and Food, Shangqiu Normal University, Shangqiu, China
- *Correspondence: Fengyi Gao, ; Wei Li,
| | - Wei Li
- Institute of Reproductive Health and Perinatology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
- *Correspondence: Fengyi Gao, ; Wei Li,
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10
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Myklebust MP, Thor A, Rosenlund B, Gjengstø P, Karlsdottir Á, Brydøy M, Bercea BS, Olsen C, Johnson I, Berg MI, Langberg CW, Andreassen KE, Kjellman A, Haugnes HS, Dahl O. Serum miR371 in testicular germ cell cancer before and after orchiectomy, assessed by digital-droplet PCR in a prospective study. Sci Rep 2021; 11:15582. [PMID: 34341387 PMCID: PMC8329070 DOI: 10.1038/s41598-021-94812-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/16/2021] [Indexed: 11/09/2022] Open
Abstract
MicroRNA-371a-3p (miR371) has been suggested as a sensitive biomarker in testicular germ cell cancer (TGCC). We aimed to compare miR371 with the classical biomarkers α-fetoprotein (AFP) and β-human chorionic gonadotropin (hCGβ). Overall, 180 patients were prospectively enrolled in the study, with serum samples collected before and after orchiectomy. We compared the use of digital droplet PCR (RT-ddPCR) with the quantitative PCR used by others for detection of miR371. The novel RT-ddPCR protocol showed high performance in detection of miR371 in serum samples. In the study cohort, miR371 was measured using RT-ddPCR. MiR371 detected CS1 of the seminoma and the non-seminoma sub-types with a sensitivity of 87% and 89%, respectively. The total sensitivity was 89%. After orchiectomy, miR371 levels declined in 154 of 159 TGCC cases. The ratio of miR371 pre- and post-orchiectomy was 20.5 in CS1 compared to 6.5 in systemic disease. AFP and hCGβ had sensitivities of 52% and 51% in the non-seminomas. MiR371 is a sensitive marker that performs better than the classical markers in all sub-types and clinical stages. Especially for the seminomas CS1, the high sensitivity of miR371 in detecting TGCC cells may have clinical implications.
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Affiliation(s)
- Mette Pernille Myklebust
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway.
| | - Anna Thor
- Department of Urology and CLINTEC Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Benedikte Rosenlund
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
| | - Peder Gjengstø
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Ása Karlsdottir
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
| | - Marianne Brydøy
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
| | | | - Christian Olsen
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
| | - Ida Johnson
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Mathilde I Berg
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | | | | | - Anders Kjellman
- Department of Urology and CLINTEC Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UIT-The Arctic University, Tromsø, Norway
| | - Olav Dahl
- Mohn Cancer Research Laboratory, Department of Oncology and Medical Physics, Haukeland University Hospital, Jonas Lies vei 91B, 5021, Bergen, Norway
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11
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Yamashita S, Kakimoto K, Uemura M, Kishida T, Kawai K, Nakamura T, Goto T, Osawa T, Yamada S, Nishimura K, Nonomura N, Kojo K, Shiraishi T, Ukimura O, Ogawa O, Shinohara N, Suzukamo Y, Ito A, Arai Y. Fertility and reproductive technology use in testicular cancer survivors in Japan: A multi-institutional, cross-sectional study. Int J Urol 2021; 28:1047-1052. [PMID: 34278620 DOI: 10.1111/iju.14645] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/23/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate fertility and use of reproductive technology of testicular cancer survivors in a multi-institutional, cross-sectional study. METHODS This study recruited testicular cancer survivors who were followed after treatment for testicular cancer at eight high-volume institutions between 2018 and 2019. The participants completed the questionnaires on marital status, fertility and use of reproductive technology. RESULTS A total of 567 testicular cancer survivors, with a median age of 43 years, responded to the questionnaire. Chemotherapy was given to 398 survivors, including three cycles of cisplatin-based chemotherapy in 106 patients and four cycles in 147 patients. Among 153 survivors who attempted sperm cryopreservation, 133 (87%) could preserve sperm. Of the 28 survivors whose cryopreserved sperm was used, 17 (61%) fathered children. Of the 72 survivors who fathered children without the use of cryopreserved sperm, 59 (82%) fathered naturally. Whereas 33 (20%) of 169 survivors treated without chemotherapy fathered children without using cryopreserved sperm, 39 (10%) of 398 treated with chemotherapy fathered children (P < 0.05). Furthermore, the paternity rate was 12% and 5% in testicular cancer survivors with three and four cycles of cisplatin-based chemotherapy, respectively (P < 0.05). However, of 121 survivors who wanted to have children, 14 (12%) received counseling about infertility treatment. CONCLUSIONS Testicular cancer survivors preserving their sperm have a higher paternity rate after chemotherapy, especially after four cycles, than those not using cryopreserved sperm. Physicians who give chemotherapy for testicular cancer need to take particular care not only with respect to recurrence of testicular cancer, but also to post-treatment fertility.
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Affiliation(s)
- Shinichi Yamashita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kenichi Kakimoto
- Department of Urology, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan
| | - Koji Kawai
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Terukazu Nakamura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan.,Department of Urology, Saiseikai Imperial Gift Foundation Inc. Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Takayuki Goto
- Department of Urology, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Takahiro Osawa
- Department of Urology, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Shigeyuki Yamada
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kosuke Kojo
- Department of Urology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Nobuo Shinohara
- Department of Urology, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yoshimi Suzukamo
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Urology, Miyagi Cancer Center, Natori, Miyagi, Japan
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12
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Tian En L, Brougham MFH, Wallace WHB, Mitchell RT. Impacts of platinum-based chemotherapy on subsequent testicular function and fertility in boys with cancer. Hum Reprod Update 2021; 26:874-885. [PMID: 32935838 PMCID: PMC7600277 DOI: 10.1093/humupd/dmaa041] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Children with cancer often face infertility as a long-term complication of their treatment. For boys, compromised testicular function is common after chemotherapy and currently there are no well-established options to prevent this damage. Platinum-based agents are used to treat a wide variety of childhood cancers. However, platinum agents are not currently included in the cyclophosphamide equivalent dose (CED), which is used clinically to assess the risks to fertility posed by combination chemotherapy in children with cancer. OBJECTIVE AND RATIONALE This was a systematic search of the literature designed to determine the evidence for effects of platinum-based cancer treatment on the prepubertal human testis in relation to subsequent testicular function and fertility. SEARCH METHODS PubMed and EMBASE were searched for articles published in English between 01 January 1966 and 05 April 2020 using search terms including 'cancer treatment', 'chemotherapy', 'human', 'prepubertal', 'testis', 'germ cells', 'testosterone' and related terms. Abstracts were screened and full-text articles were obtained for those that met the three major inclusion criteria (age ≤12 years at treatment, exposure to platinum-based chemotherapeutic and measure of reproductive function). Screening of bibliographies for full-text articles was used to identify additional studies. OUTCOMES Our initial search identified 1449 articles of which 20 (1.3%) studies (n = 13 759 males) met all inclusion criteria. A control group (healthy individuals or siblings) was included for 5/20 (25%) studies. A total of 10/20 (50%) studies provided sub-analysis of the relative gonadotoxicity of platinum-based agents.The primary outcome measures were: pregnancies and fatherhood; semen analysis; and hormonal function. For pregnancies and fatherhood, three studies (n = 10 453 males) reported negative associations with platinum-agents, including the largest (n = 5640) controlled study (hazard ratio = 0.56, P = 0.0023), whilst two other studies (n = 1781) with platinum sub-analysis reported no association. For semen analysis (based on World Health Organization criteria), platinum-based chemotherapy was associated with azoospermia in one study (n = 129), whilst another (n = 44) found no association and the remainder did not perform platinum-based sub-analysis. For hormone analysis, conflicting results were obtained regarding potential associations between platinum-based agents and elevated FSH (a proxy for impaired spermatogenesis); however, the majority of these studies were based on low numbers of patients receiving platinum-based chemotherapy. WIDER IMPLICATIONS Overall, these results indicate that platinum-based chemotherapy should be included in clinical calculators, for example CED, used to determine gonadotoxicity for childhood cancer treatment. These findings have important implications for clinicians regarding counselling patients and their carer(s) on fertility risk, guiding requirements for fertility preservation strategies (e.g. testicular tissue cryopreservation) and modification of treatments to reduce or eliminate the risk of infertility in childhood cancer survivors.
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Affiliation(s)
- Lim Tian En
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Mark F H Brougham
- Department of Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | | | - Rod T Mitchell
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK.,Department of Paediatric Endocrinology, Royal Hospital for Sick Children, Edinburgh, UK
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13
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Fujiwara M, Tanaka H, Yuasa T, Komai Y, Oguchi T, Fujiwara R, Numao N, Yamamoto S, Fujii Y, Fukui I, Yonese J. First-line combination chemotherapy with etoposide, ifosfamide and cisplatin for the treatment of disseminated germ cell cancer: Efficacy and feasibility in current clinical practice. Int J Urol 2021; 28:920-926. [PMID: 34028113 DOI: 10.1111/iju.14604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety profiles of first-line etoposide, ifosfamide and cisplatin and primary prophylaxis with pegfilgrastim as first-line chemotherapy for disseminated germ cell cancer. METHODS This study reviewed 154 consecutive patients with previously untreated disseminated germ cell cancer who received first-line etoposide, ifosfamide and cisplatin between 1995 and 2020. Of these, 54 patients were managed with primary prophylaxis using pegfilgrastim (primary prophylaxis group), and 100 were managed with the therapeutic use of short-acting granulocyte colony-stimulating factor (non-primary prophylaxis group). RESULTS The International Germ Cell Cancer Collaborative Group classification identified 90 (58%)/40 (26%)/24 (16%) patients with good/intermediate/poor prognosis, respectively. Overall, 139 patients (90%) were disease free after etoposide, ifosfamide and cisplatin with/without post-chemotherapy surgery. The median relative dose intensity of etoposide, ifosfamide and cisplatin was 96%, and there was a significant difference between the primary prophylaxis and non-primary prophylaxis groups (100% vs 90%, P < 0.01). The 5-year salvage treatment-free and overall survival rates were 83% and 94%, respectively. In total, 138 patients (90%) developed grade 4 hematological toxicities, and there were no treatment-related deaths due to myelosuppression. Grade 4 neutropenia was less commonly observed in the primary prophylaxis group compared with the non-primary prophylaxis group (80% vs 95%, P < 0.01). CONCLUSIONS This is the largest study of first-line etoposide, ifosfamide and cisplatin, and its sufficient efficacy and safety profiles are confirmed in current clinical practice. Primary prophylaxis using pegfilgrastim might further improve the feasibility of etoposide, ifosfamide and cisplatin.
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Affiliation(s)
- Motohiro Fujiwara
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Takeshi Yuasa
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinobu Komai
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiko Oguchi
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ryo Fujiwara
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Noboru Numao
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinya Yamamoto
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Iwao Fukui
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Yonese
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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14
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Melatonin protects rats testes against bleomycin, etoposide, and cisplatin-induced toxicity via mitigating nitro-oxidative stress and apoptosis. Biomed Pharmacother 2021; 138:111481. [PMID: 33752059 DOI: 10.1016/j.biopha.2021.111481] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/01/2021] [Accepted: 03/06/2021] [Indexed: 12/18/2022] Open
Abstract
There is growing concern that some cytotoxic regimens for cancer adversely affect spermatogenesis and male fertility. Increasing evidence demonstrated that melatonin has beneficial impacts on reproductive processes; however, whether melatonin can protect against bleomycin, etoposide, and cisplatin (BEP) chemotherapy regimen-induced testicular toxicity, remains obscure. The present study aimed to explore the effect of melatonin on BEP-evoked testicular injury in rats. Adult male Wistar rats (n = 10/group) were intraperitoneally (i.p.) injected with one cycle of 21 days of 0.33 therapeutically relevant dose levels of BEP (.5 mg/kg bleomycin, 5 mg/kg etoposide, and 1 mg/kg cisplatin) with or without melatonin. At the end of the study, sperm parameters, testosterone level, stereology of testes, testicular levels of malondialdehyde (MDA), nitric oxide (NO), and total antioxidant capacity (TAC), the expression of apoptosis-associated genes such as Bcl2, Bax, Caspase-3, p53, and TNF-α (Real-time PCR and Immunohistochemistry) were evaluated. Our findings showed that melatonin restored spermatogenesis by improving sperm count, motility, viability, and morphology. Testosterone level, histopathology, and stereology of testes were significantly improved in melatonin-administrated groups. Furthermore, melatonin recovered the oxidative status of the testes through elevating TAC and ameliorating MDA and NO levels. More importantly, melatonin therapy suppressed BEP-evoked apoptosis by modulating Bcl-2, Bax, Caspase-3, p53, and TNF-α expression in testes. In conclusion, melatonin protects the testes against BEP-induced testicular damage by attenuating nitro-oxidative stress, apoptosis, and inflammation, which provides evidence for melatonin as a possible clinical therapy against BEP-associated gonadotoxicity and male sub/infertility.
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15
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Hellesnes R, Myklebust TÅ, Bremnes RM, Karlsdottir Á, Kvammen Ø, Negaard HFS, Tandstad T, Wilsgaard T, Fosså SD, Haugnes HS. Metachronous Contralateral Testicular Cancer in the Cisplatin Era: A Population-Based Cohort Study. J Clin Oncol 2020; 39:308-318. [PMID: 33356420 DOI: 10.1200/jco.20.02713] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE It is hypothesized that cisplatin-based chemotherapy (CBCT) reduces the occurrence of metachronous contralateral (second) germ cell testicular cancer (TC). However, studies including treatment details are lacking. The aim of this study was to assess the second TC risk, emphasizing the impact of previous TC treatment. PATIENTS AND METHODS Based on the Cancer Registry of Norway, 5,620 men were diagnosed with first TC between 1980 and 2009. Treatment data regarding TC were retrieved from medical records. Cumulative incidences of second TC were estimated, and standardized incidence ratios were calculated. The effect of treatment intensity was investigated using Cox proportional hazard regression. RESULTS Median follow-up was 18.0 years, during which 218 men were diagnosed with a second TC after median 6.2 years. Overall, the 20-year crude cumulative incidence was 4.0% (95% CI, 3.5 to 4.6), with lower incidence after chemotherapy (CT) (3.2%; 95% CI, 2.5 to 4.0) than after surgery only (5.4%; 95% CI, 4.2 to 6.8). The second TC incidence was also lower for those age ≥ 30 years (2.8%; 95% CI, 2.3 to 3.4) at first TC diagnosis than those age < 30 years (6.0%; 95% CI, 5.0 to 7.1). Overall, the second TC risk was 13-fold higher compared with the risk of developing TC in the general male population (standardized incidence ratio, 13.1; 95% CI, 11.5 to 15.0). With surgery only as reference, treatment with CT significantly reduced the second TC risk (hazard ratio [HR], 0.55). For each additional CBCT cycle administered, the second TC risk decreased significantly after three, four, and more than four cycles (HRs, 0.53, 0.41, and 0.21, respectively). CONCLUSION Age at first TC diagnosis and treatment intensity influenced the second TC risk, with significantly reduced risks after more than two CBCT cycles.
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Affiliation(s)
- Ragnhild Hellesnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Roy M Bremnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Ása Karlsdottir
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Øivind Kvammen
- Department of Oncology, Ålesund Hospital, Ålesund, Norway
| | | | - Torgrim Tandstad
- The Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Sophie D Fosså
- Department of Registration, Cancer Registry of Norway, Oslo, Norway.,Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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16
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Abstract
PURPOSE OF REVIEW Hypogonadism is highly prevalent among not only patients with a history of prior treatment for cancer, but also among those patients with a new oncologic diagnosis who have not yet received any cancer therapy. Hypogonadism can cause a wide array of signs and symptoms including: deceased muscle mass; increased fat mass; decreased energy, mood, and overall sense of well being; diminished bone mineral density; infertility; and impaired libido and sexual function. This purpose of this manuscript is to review the mechanisms by which cancer and oncologic treatment regimens can adversely affect the hypothalamic pituitary gonadal axis, resulting in hypogonadism. Risks and benefits associated with the treatment of testosterone deficiency are also discussed, which are important considerations for clinicians caring for affected patients. RECENT FINDINGS Hypogonadism has a high prevalence in the setting of cancer and is an important survivorship issue. Recent randomized controlled trials confirm testosterone's therapeutic benefits in terms of sexual function, mood body composition, and bone health, but the specific benefits in terms of quality of life are less clear. SUMMARY More prospective studies are needed to further delineate the risks, benefits, and overall outcomes of testosterone replacement therapy in patients with cancer and cancer survivors.
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Affiliation(s)
- Cory A Faw
- Northwestern University, Feinberg School of Medicine, Department of Urology, Chicago, Illinois, USA
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17
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Elrashidy RA, Hasan RA. Stromal cell-derived factor-1α predominantly mediates the ameliorative effect of linagliptin against cisplatin-induced testicular injury in adult male rats. Cytokine 2020; 136:155260. [DOI: 10.1016/j.cyto.2020.155260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 08/09/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022]
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18
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Anderson KH, Romao RLP. Testicular tumors in children and adolescents: long-term endocrine and fertility issues. Transl Androl Urol 2020; 9:2393-2399. [PMID: 33209712 PMCID: PMC7658154 DOI: 10.21037/tau-19-923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The treatment modalities for testicular tumors (surgery, chemotherapy, and radiotherapy), have different associated gonadotoxic risks and the overall survival for most pediatric patients with testicular tumors is very good. However, necessary treatments may lead to the development of lasting gonadal dysfunction and subsequent negative health and quality of life impact. Research with long-term follow-up for patients who have undergone surgery as the sole treatment modality for testicular tumors in childhood are lacking. It is currently unclear if surgery leads to long-term negative functional outcomes. Alkylating agents (e.g., cyclophosphamide) have long been known to increase risk of infertility; platinum-based therapies used frequently for patients with germ-cell tumors (GCTs) also seem to carry some risk of gonadotoxicity, although they have not been as well studied. Radiotherapy to the gonads is toxic and Leydig cells are particularly sensitive to high doses of radiation (>12 Gy). Long-term fertility and hormonal impact vary based on the patient’s age, as well as the type and intensity of the oncological treatment prescribed. Counselling regarding fertility risk and preservation options should ideally take place before initiating potentially gonadotoxic treatments. Hypogonadism in peri-pubertal boys can present as delayed onset or failure to progress through puberty. Sperm cryopreservation should be offered for post-pubertal boys who are able to provide a semen sample. For prepubertal boys or young males who cannot provide a semen sample, only experimental options are currently available. Much of the data reviewed here is extrapolated from research done on adult males whose reproductive and hormonal outcomes may not be comparable to younger patients who do not yet have fully developed reproductive systems. Currently, a lack of good quality evidence in this age range causes this restriction to be unavoidable. Patients and their families want to be informed of the risks and treatment options for preserving testicular function. As research continues in this field, it grows more important for urologists to be aware of the outcomes and options for their patients.
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Affiliation(s)
- Katherine H Anderson
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Rodrigo L P Romao
- Division of Pediatric Urology, IWK Health Centre, Department of Urology, Dalhousie University, Halifax, NS, Canada
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19
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McHugh D, Bosl GJ, Funt SA, Feldman DR. Reply to L.H. Einhorn et al. J Clin Oncol 2020; 38:3074-3075. [PMID: 32634335 DOI: 10.1200/jco.20.01339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Deaglan McHugh
- Deaglan McHugh, MD, Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Department of Medicine, Weill Medical College of Cornell University, New York, NY; George J. Bosl, MD, Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; and Samuel A. Funt, MD and Darren R. Feldman, MD, Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Medical College of Cornell University, New York, NY
| | - George J Bosl
- Deaglan McHugh, MD, Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Department of Medicine, Weill Medical College of Cornell University, New York, NY; George J. Bosl, MD, Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; and Samuel A. Funt, MD and Darren R. Feldman, MD, Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Medical College of Cornell University, New York, NY
| | - Samuel A Funt
- Deaglan McHugh, MD, Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Department of Medicine, Weill Medical College of Cornell University, New York, NY; George J. Bosl, MD, Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; and Samuel A. Funt, MD and Darren R. Feldman, MD, Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Medical College of Cornell University, New York, NY
| | - Darren R Feldman
- Deaglan McHugh, MD, Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Department of Medicine, Weill Medical College of Cornell University, New York, NY; George J. Bosl, MD, Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; and Samuel A. Funt, MD and Darren R. Feldman, MD, Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Medical College of Cornell University, New York, NY
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20
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Fung C, Dinh PC, Fossa SD, Travis LB. Testicular Cancer Survivorship. J Natl Compr Canc Netw 2020; 17:1557-1568. [PMID: 31805527 DOI: 10.6004/jnccn.2019.7369] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/14/2019] [Indexed: 11/17/2022]
Abstract
Testicular cancer (TC) is the most common cancer among men aged 18 to 39 years. It is highly curable, with a 10-year relative survival approaching 95% due to effective cisplatin-based chemotherapy. Given the increasing incidence of TC and improved survival, TC survivors (TCS) now account for approximately 4% of all US male cancer survivors. They have also become a valuable cohort for adult-onset cancer survivorship research, given their prolonged survival. Commensurately, long-term treatment-related complications have emerged as important survivorship issues. These late effects include life-threatening conditions, such as second malignant neoplasms and cardiovascular disease. Moreover, TCS can also experience hearing loss, tinnitus, neurotoxicity, nephrotoxicity, pulmonary toxicity, hypogonadism, infertility, anxiety, depression, cognitive impairment, and chronic cancer-related fatigue. Characterization of the number and severity of long-term adverse health outcomes among TCS remains critical to develop risk-stratified, evidence-based follow-up guidelines and to inform the development of preventive measures and interventions. In addition, an improved understanding of the long-term effects of TC treatment on mortality due to noncancer causes and second malignant neoplasms remains paramount. Future research should focus on the continued development of large, well-characterized clinical cohorts of TCS for lifelong follow-up. These systematic, comprehensive approaches can provide the needed infrastructure for further investigation of long-term latency patterns of various medical and psychosocial morbidities and for more in-depth studies investigating associated etiopathogenetic pathways. Studies examining premature physiologic aging may also serve as new frontiers in TC survivorship research.
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Affiliation(s)
- Chunkit Fung
- aUniversity of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Paul C Dinh
- bIndiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.,cDepartment of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana; and
| | | | - Lois B Travis
- bIndiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
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21
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Fosså SD, Dahl AA, Myklebust TÅ, Kiserud CE, Nome R, Klepp OH, Brydøy M, Haugnes HS. Risk of positive selection bias in longitudinal surveys among cancer survivors: Lessons learnt from the national Norwegian Testicular Cancer Survivor Study. Cancer Epidemiol 2020; 67:101744. [PMID: 32652337 DOI: 10.1016/j.canep.2020.101744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Selection bias due to non- or incomplete compliance is challenging in surveys. Using data from a longitudinal survey in testicular cancer survivors (TCSs), we identify factors predicting incomplete compliance. METHOD In a questionnaire-based national survey (1998-2016; three waves) 1,813 > 5 year TCSs were invited to report post-treatment adverse health outcomes (AHOs). We separated complete from partial participants (participation in all three waves versus participation only once or twice). At each wave we additionally identified responders and non-responders based on their questionnaire return at the respective wave. Multivariable logistic regression analysis identified associations between AHOs reported at the first wave and partial participation. Survival differences between Responders and Non-Responders were assessed by the Kaplan-Meier estimate and the logrank test. Level of significance: p < 0.05. RESULTS Of 1813 TCSs 1,346 TCSs (79 %) completed the first wave's questionnaire, and 783 (58 %) became complete and 653 (42 %) partial participants. Poor socio-economics, unhealthy life style, major co-morbidity and chemotherapy-related AHOs reported at the first survey wave were associated with a significant 1.5-1.9 times increased risk for partial participation. At the two last waves non-responders had significantly decreased overall survival compared with responders. CONCLUSION Our longitudinal study indicates positive selection bias during the 17 years of a longitudinal survey among TCSs, with fewer AHOs among Complete than among Partial Participants. If not sufficiently compensated for by data from external sources and/or statistical methods, attrition bias in longitudinal surveys may limit the external validity of findings related to cancer survivors' self-reported AHOs.
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Affiliation(s)
- Sophie D Fosså
- Department of Oncology, National Resource Center for Late Effects after Cancer Treatment, Oslo University Hospital, Norway; Faculty of Medicine, University of Oslo, Norway.
| | - Alv A Dahl
- Department of Oncology, National Resource Center for Late Effects after Cancer Treatment, Oslo University Hospital, Norway
| | - Tor Å Myklebust
- Department of Registration, Cancer Registry Norway, Oslo &Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Cecile E Kiserud
- Department of Oncology, National Resource Center for Late Effects after Cancer Treatment, Oslo University Hospital, Norway
| | - Ragnhild Nome
- Department of Medical Biochemistry, Oslo University Hospital, Oslo & Faculty of Medicine, University of Oslo, Norway
| | - Olbjørn H Klepp
- Department of Oncology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Marianne Brydøy
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Department of Clinical Medicine, University in Tromsø, The Arctic University, Tromsø, Norway
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22
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Gerstl B, Bertoldo MJ, Sullivan E, Volckmar X, Kerr A, Wand H, Ives A, Albalawi O, Anazodo A. Fatherhood Following Treatment for Testicular Cancer: A Systematic Review and Meta-Analyses. J Adolesc Young Adult Oncol 2020; 9:341-353. [DOI: 10.1089/jayao.2019.0164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brigitte Gerstl
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
- Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia
| | - Michael J. Bertoldo
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Elizabeth Sullivan
- Faculty Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Xanthie Volckmar
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Aidan Kerr
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Handan Wand
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Angela Ives
- Cancer and Palliative Care Research and Evaluation Unit, University of Western Australia, Crawley, Australia
| | - Olayan Albalawi
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Statistics, Science College, Tabuk University, Tabuk, Saudi Arabia
| | - Antoinette Anazodo
- Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Nelune Comprehensive Cancer Center, Prince of Wales Hospital, Sydney, Australia
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23
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Labbate CV, Werntz RP, Galansky LB, Packiam VT, Eggener SE. National management trends in clinical stage IIA nonseminomatous germ cell tumor (NSGCT) and opportunities to avoid dual therapy. Urol Oncol 2020; 38:687.e13-687.e18. [PMID: 32305267 DOI: 10.1016/j.urolonc.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/08/2020] [Accepted: 03/17/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION For marker-negative clinical stage (CS) IIA nonseminomatous germ cell tumor (NSGCT), National Comprehensive Cancer Network and American Urological Association guidelines recommend either retroperitoneal lymph node dissection (RPLND) or induction chemotherapy. The goal is cure with one form of therapy. We evaluated national practice patterns in the management of CSIIA NSGCT and utilization of secondary therapies. METHODS The National Cancer Data Base was used to identify 400 men diagnosed with marker negative CSIIA NSGCT between 2004 and 2014 treated with RPLND or chemotherapy. Trends in the utilization of initial and adjuvant treatment (chemotherapy only, RPLND only, RPLND with adjuvant chemotherapy, and postchemotherapy RPLND) were analyzed. RESULTS Of the 400 cases, 233 (58%) underwent induction chemotherapy with surveillance, 51 (20%) underwent RPLND with surveillance, 89 (22%) underwent RPLND followed by adjuvant chemotherapy, and 14 (4%) underwent induction chemotherapy followed by RPLND. Thirty percent of patients received dual therapy. After RPLND with pN1 staging, 43 (61%) underwent adjuvant chemotherapy. The pN0 rate after primary RPLND was 22%. Five year overall survival ranged from 95% to 100% based on initial treatment choice. CONCLUSIONS For marker negative CS IIA nonseminoma, dual, therapy, and treatment with chemotherapy is common. With low volume retroperitoneal disease resected at RPLND, adjuvant chemotherapy was frequently administered but has debatable therapeutic value. These data highlight opportunities to decrease treatment burden in patients with CS IIA nonseminoma.
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Affiliation(s)
- Craig V Labbate
- Section of Urology, University of Chicago Medicine, Chicago, IL.
| | - Ryan P Werntz
- Prisma Health-Upstate, Section of Urology, Department of Surgery, University of South Carolina-Greenville
| | | | | | - Scott E Eggener
- Section of Urology, University of Chicago Medicine, Chicago, IL
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24
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Halpern JA, Das A, Faw CA, Brannigan RE. Oncofertility in adult and pediatric populations: options and barriers. Transl Androl Urol 2020; 9:S227-S238. [PMID: 32257863 PMCID: PMC7108982 DOI: 10.21037/tau.2019.09.27] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Cancer and its treatments can affect fertility in a variety of ways, and recent advances in cancer detection and treatment have led to an increasing number of cancer survivors for whom future fertility is a primary concern. Oncofertility is the study of interactions between cancer, anti-cancer therapy, fertility, and reproductive health. Fertility preservation aims to optimize fertility potential before initiation of gonadotoxic therapies. Sperm cryopreservation from an ejaculated sample is the gold standard for adults and post-pubertal adolescents, though added maneuvers such as medical therapy, penile vibratory stimulation, and electroejaculation can be employed when appropriate. When all these approaches fail, testicular sperm extraction can be used to obtain and cryopreserve testicular sperm from the azoospermic patient. Fertility preservation in the pre-pubertal pediatric patient is still experimental, but recent scientific breakthroughs with use of spermatogonial stem cells and testicular tissue transplantation offer great promise for the future. While there may be several practical, cultural, religious, and other barriers to fertility preservation, the establishment of a dedicated fertility preservation team can help to overcome these obstacles and optimize the utilization of fertility preservation in cancer patients of all ages.
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Affiliation(s)
- Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arighno Das
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cory A Faw
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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25
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Cullen M, Huddart R, Joffe J, Gardiner D, Maynard L, Hutton P, Mazhar D, Shamash J, Wheater M, White J, Goubar A, Porta N, Witts S, Lewis R, Hall E. The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in High-risk, Stage 1 Nonseminomatous or Combined Germ Cell Tumours of the Testis. Eur Urol 2020; 77:344-351. [PMID: 31901440 PMCID: PMC7026695 DOI: 10.1016/j.eururo.2019.11.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/26/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Standard management in the UK for high-risk stage 1 nonseminoma germ cell tumours of the testis (NSGCTT) is two cycles of adjuvant bleomycin, etoposide (360 mg/m2), and cisplatin (BE360P) chemotherapy, or surveillance. OBJECTIVE To test whether one cycle of BE500P achieves similar recurrence rates to two cycles of BE360P. DESIGN, SETTING, AND PARTICIPANTS A total of 246 patients with vascular invasion-positive stage 1 NSGCTT or combined seminoma + NSGCTT were centrally registered in a single-arm prospective study. INTERVENTION One cycle comprising bleomycin 30000 IU on days 1, 8, and 15, etoposide 165 mg/m2 on days 1-3, and cisplatin 50 mg/m2 on days 1-2, plus antibacterial and granulocyte colony stimulating factor prophylaxis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was 2-yr malignant recurrence (MR); the aim was to exclude a rate of ≥5%. Participants had regular imaging and tumour marker (TM) assessment for 5 yr. RESULTS AND LIMITATIONS The median follow-up was 49 mo (interquartile range 37-60). Ten patients with rising TMs at baseline were excluded. Four patients had MR at 6, 7, 13, and 27 mo; all received second-line chemotherapy and surgery and three remained recurrence-free at 5 yr. The 2-yr MR rate was 1.3% (95% confidence interval 0.3-3.7%). Three patients developed nonmalignant recurrences with localised teratoma differentiated, rendered disease-free after surgery. Grade 3-4 febrile neutropenia occurred in 6.8% of participants. CONCLUSIONS BE500P is safe and the 2-yr MR rate is consistent with that seen following two BE360P cycles. The 111 study is the largest prospective trial investigating one cycle of adjuvant BE500P in high-risk stage 1 NSGCTT. Adoption of one cycle of BE500P as standard would reduce overall exposure to chemotherapy in this young population. PATIENT SUMMARY Removing the testicle fails to cure many patients with high-risk primary testicular cancer since undetectable cancers are often present elsewhere. A standard additional treatment in Europe is two cycles of chemotherapy to eradicate these. This trial shows one cycle has few adverse effects and comparable outcomes to those seen with two cycles.
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Affiliation(s)
- Michael Cullen
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Robert Huddart
- The Institute Of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | | | - Deborah Gardiner
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Lauren Maynard
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Paul Hutton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Danish Mazhar
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Matthew Wheater
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jeff White
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Aicha Goubar
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Nuria Porta
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Stephanie Witts
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Rebecca Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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26
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Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, Clarke N, Cohn-Cedermark G, Daugaard G, Dieckmann KP, Fizazi K, Fosså S, Germa-Lluch JR, Giannatempo P, Gietema JA, Gillessen S, Haugnes HS, Heidenreich A, Hemminki K, Huddart R, Jewett MAS, Joly F, Lauritsen J, Lorch A, Necchi A, Nicolai N, Oing C, Oldenburg J, Ondruš D, Papachristofilou A, Powles T, Sohaib A, Ståhl O, Tandstad T, Toner G, Horwich A. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol 2019; 29:1658-1686. [PMID: 30113631 DOI: 10.1093/annonc/mdy217] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany.
| | - J Aparicio
- Department of Medical Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - D Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Beyer
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - R Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - N Clarke
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K-P Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Fosså
- Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - J R Germa-Lluch
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain
| | - P Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern, Switzerland
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UIT - The Arctic University, Tromsø, Norway
| | - A Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Specialised Urologic Surgery, University of Cologne, Cologne, Germany
| | - K Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - M A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - F Joly
- Department of Urology-Gynaecology, Centre Francois Baclesse, Caen, France
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lorch
- Department of Urology, Genitourinary Medical Oncology, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - N Nicolai
- Department of Surgery, Urology and Testis Surgery Unit, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - D Ondruš
- 1st Department of Oncology, St. Elisabeth Cancer Institute, Comenius University Faculty of Medicine, Bratislava, Slovak Republic
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - T Powles
- Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A Sohaib
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - T Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - G Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - A Horwich
- The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
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27
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Stoneham S, Murray M, Thomas B, Williamson M, Sweeney C, Frazier L. AYA testis cancer: The unmet challenge. Pediatr Blood Cancer 2019; 66:e27796. [PMID: 31066223 DOI: 10.1002/pbc.27796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 12/12/2022]
Abstract
Testis cancer is considered a rare-incidence cancer but comprises the third most common cancer diagnosed within the adolescent and young adult (AYA) years (15-39 years). Most testis cancer patients can anticipate a survival outcome in excess of 95%. However, there are subgroups of AYA patients where outcomes are considerably worse, including younger adolescents, patients with certain histological subtypes, or from certain ethnic backgrounds. For those cured with chemotherapy, the toxicity of treatment and burden of late effects is significant. Newer germ cell tumor-specific biomarkers may identify patients who do not require further treatment interventions or may detect early recurrence, potentially reducing the burden of treatment required for cure. An international collaboration for this rare tumor is creating the forum for trial design, where these biomarker research questions are embedded. Going forward, AYA testis cancer patients could benefit from having a more personalized treatment plan, tailored to risk, that minimizes the overall burden of late effects.
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Affiliation(s)
- Sara Stoneham
- Department of Paediatrics and Child Health, University College Hospital London NHS Foundation Trust, London, UK
| | - Matthew Murray
- Department of Pathology, University of Cambridge, UK.,Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Benjamin Thomas
- Oncology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Max Williamson
- Life Sciences Faculty, University College London, London, UK
| | - Christopher Sweeney
- Dana-Farber Cancer Institute, Department of Medical Oncology and Division of Population Sciences, Boston, Massachusetts
| | - Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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28
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Poorvu PD, Frazier AL, Feraco AM, Manley PE, Ginsburg ES, Laufer MR, LaCasce AS, Diller LR, Partridge AH. Cancer Treatment-Related Infertility: A Critical Review of the Evidence. JNCI Cancer Spectr 2019; 3:pkz008. [PMID: 31360893 PMCID: PMC6649805 DOI: 10.1093/jncics/pkz008] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/08/2019] [Accepted: 03/12/2019] [Indexed: 12/15/2022] Open
Abstract
Cancer treatments may compromise the fertility of children, adolescents, and young adults, and treatment-related infertility represents an important survivorship issue that should be addressed at diagnosis and in follow-up to ensure optimal decision-making, including consideration of pursuing fertility preservation. Risk of infertility varies substantially with patient and treatment factors. The ability to accurately assess fertility risk for many patients is hampered by limitations of the current literature, including heterogeneity in patient populations, treatments, and outcome measures. In this article, we review and synthesize the available data to estimate fertility risks from modern cancer treatments for both children and adult cancer survivors to enable clinicians to counsel patients about future fertility.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ann H Partridge
- Correspondence to: Ann H. Partridge, MD, MPH, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215-5450 (e-mail: .)
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29
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Hamilton RJ, Nayan M, Anson-Cartwright L, Atenafu EG, Bedard PL, Hansen A, Chung P, Warde P, Sweet J, O'Malley M, Sturgeon J, Jewett MAS. Treatment of Relapse of Clinical Stage I Nonseminomatous Germ Cell Tumors on Surveillance. J Clin Oncol 2019; 37:1919-1926. [PMID: 30802156 DOI: 10.1200/jco.18.01250] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Active surveillance (AS) for testicular nonseminomatous germ cell tumors (NSGCT) is widely used. Although there is no consensus for optimal treatment at relapse on surveillance, globally patients typically receive chemotherapy. We describe treatment of relapses in our non-risk-adapted NSGCT AS cohort and highlight selective use of primary retroperitoneal lymph node dissection (RPLND). METHODS From December 1980 to December 2015, 580 patients with clinical stage I NSGCT were treated with AS, and 162 subsequently relapsed. First-line treatment was based on relapse site and extent. Logistic regression was used to explore factors associated with need for multimodal therapy on AS relapse. RESULTS Median time to relapse was 7.4 months. The majority of relapses were confined to the retroperitoneum (66%). After relapse, first-line treatment was chemotherapy for 95 (58.6%) and RPLND for 62 (38.3%), and five patients (3.1%) underwent other therapy. In 103 (65.6%), only one modality of treatment was required: chemotherapy only in 58 of 95 (61%) and RPLND only in 45 of 62 (73%). Factors associated with multimodal relapse therapy were larger node size (odds ratio, 2.68; P = .045) in patients undergoing chemotherapy and elevated tumor markers (odds ratio, 6.05; P = .008) in patients undergoing RPLND. When RPLND was performed with normal markers, 82% required no further treatment. Second relapse occurred in 30 of 162 patients (18.5%). With median follow-up of 7.6 years, there were five deaths (3.1% of AS relapses, but 0.8% of whole AS cohort) from NSGCT or treatment complications. CONCLUSION The retroperitoneum is the most common site of relapse in clinical stage I NSGCT on AS. Most are cured by single-modality treatment. RPLND should be considered for relapsed patients, especially those with disease limited to the retroperitoneum and normal markers, as an option to avoid chemotherapy.
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Affiliation(s)
- Robert J Hamilton
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,2The University of Toronto, Toronto, Ontario, Canada
| | - Madhur Nayan
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,2The University of Toronto, Toronto, Ontario, Canada
| | - Lynn Anson-Cartwright
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,2The University of Toronto, Toronto, Ontario, Canada
| | - Eshetu G Atenafu
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Philippe L Bedard
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Aaron Hansen
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Peter Chung
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Padraig Warde
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Joan Sweet
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Martin O'Malley
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jeremy Sturgeon
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael A S Jewett
- 1Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,2The University of Toronto, Toronto, Ontario, Canada
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De Padova S, Casadei C, Berardi A, Bertelli T, Filograna A, Cursano MC, Menna C, Burgio SL, Altavilla A, Schepisi G, Prati S, Montalti S, Chovanec M, Banna GL, Grassi L, Mego M, De Giorgi U. Caregiver Emotional Burden in Testicular Cancer Patients: From Patient to Caregiver Support. Front Endocrinol (Lausanne) 2019; 10:318. [PMID: 31191451 PMCID: PMC6546807 DOI: 10.3389/fendo.2019.00318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/01/2019] [Indexed: 12/15/2022] Open
Abstract
Testicular cancer is the most common tumor in young males aged 15-40 years. The overall cure rate for men with testicular cancer is >90%, so a huge number of these patients will become testicular cancer survivors. These people may feel some stress in the experience of diagnosis, treatment, and consequences that affects the quality of life, and during follow-up, especially when new issues and emotional distresses appear over time, such as late side-effects of treatments and emotional challenges including fear of tumor relapse, fertility and sexuality concerns, and social and workplace issues. The cancer experience has an impact not only on patients, but also on their relatives (e.g., spouses, parents, or siblings), who often have to assume a caregiving role for the duration of and following treatment for cancer. Moreover, the caregiver plays an important role in supporting a man with a testicular cancer, providing physical and emotional care. This review presents a summary of existing knowledge regarding the impact and the burden of testicular cancer on caregivers.
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Affiliation(s)
- Silvia De Padova
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Chiara Casadei
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Alejandra Berardi
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Tatiana Bertelli
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Alessia Filograna
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | | | - Cecilia Menna
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Salvatore Luca Burgio
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Amelia Altavilla
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Giuseppe Schepisi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Sabrina Prati
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Sandra Montalti
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | - Michal Chovanec
- Medical Oncology Department, Campus Bio-Medico University, Rome, Italy
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | | | - Luigi Grassi
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, St. Anna University Hospital and NHS Community Health Trusts, Ferrara, Italy
| | - Michal Mego
- Medical Oncology Department, Campus Bio-Medico University, Rome, Italy
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Ugo De Giorgi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
- *Correspondence: Ugo De Giorgi
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Hjelle LV, Gundersen POM, Hellesnes R, Sprauten M, Brydøy M, Tandstad T, Wilsgaard T, Fosså SD, Oldenburg J, Bremnes RM, Haugnes HS. Long-term serum platinum changes and their association with cisplatin-related late effects in testicular cancer survivors. Acta Oncol 2018; 57:1392-1400. [PMID: 29775128 DOI: 10.1080/0284186x.2018.1473641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND The long-term toxicities after cisplatin-based chemotherapy (CBCT) reveal a remarkable inter-individual variation among testicular cancer survivors (TCSs). Therefore, we assessed long-term platinum (Pt) changes and their associations with CBCT-related late effects in TCSs. MATERIAL AND METHODS In 77 TCSs treated with CBCT from 1984 to 1990, blood samples for analyses of Pt and a questionnaire including self-reported neuro- and ototoxicity (NTX) symptoms were collected during two follow-up surveys at median 12 (Survey I; SI) and 20 (Survey II; SII) years after treatment. Information about second cancers after SII was retrieved from the Norwegian Cancer Registry. RESULTS A larger Pt decline from SI to SII was associated with a decreased risk of a second cancer diagnosis (HR 0.78, 95% CI 0.62-0.99 per 10 ng/L/year), and worsening of paresthesias in hands (OR 1.98, 95% CI 1.09-3.59 per 10 ng/L/year) and tinnitus (OR 1.51, 95% CI 1.01-2.27 per 10 ng/L/year). CONCLUSION In summary, we found a significant association between a larger Pt decline and a reduced risk of second cancers and deterioration of paresthesias in hands and tinnitus.
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Affiliation(s)
- Line V. Hjelle
- Department of Clinical Medicine, Arctic University of Tromsø, Norway
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Per O. M. Gundersen
- Department of Clinical Pharmacology, St. Olav’s University Hospital, Trondheim, Norway
| | - Ragnhild Hellesnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Mette Sprauten
- Department of Oncology, Oslo University Hospital the Norwegian Radium Hospital, Oslo, Norway
| | - Marianne Brydøy
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Torgrim Tandstad
- The cancer Clinic, St. Olav’s University Hospital, Trondheim, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, Arctic University of Tromsø, Tromsø, Norway
| | - Sophie D. Fosså
- Department of Oncology, Oslo University Hospital the Norwegian Radium Hospital, Oslo, Norway
- Medical Faculty, University of Oslo, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Jan Oldenburg
- Medical Faculty, University of Oslo, Norway
- Department of Oncology, Akershus University Hospital, Oslo, Norway
| | - Roy M. Bremnes
- Department of Clinical Medicine, Arctic University of Tromsø, Norway
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Hege S. Haugnes
- Department of Clinical Medicine, Arctic University of Tromsø, Norway
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
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Namekawa T. Editorial Comment from Dr Namekawa to Differences in semen characteristics between patients with testicular cancer and other malignancies using various cut-off values. Int J Urol 2018; 25:824. [PMID: 30068021 DOI: 10.1111/iju.13765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Takeshi Namekawa
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Moody JA, Ahmed K, Yap T, Minhas S, Shabbir M. Fertility managment in testicular cancer: the need to establish a standardized and evidence-based patient-centric pathway. BJU Int 2018; 123:160-172. [DOI: 10.1111/bju.14455] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jemma A. Moody
- GKT School of Medical Education; King's College London; London UK
- College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
| | - Kamran Ahmed
- GKT School of Medical Education; King's College London; London UK
- Department of Urology; Guy's Hospital; London UK
| | - Tet Yap
- Department of Urology; Guy's Hospital; London UK
| | - Suks Minhas
- Imperial College Healthcare; NHS Trust; London UK
| | - Majid Shabbir
- GKT School of Medical Education; King's College London; London UK
- Department of Urology; Guy's Hospital; London UK
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Fertility preservation for men with testicular cancer: Is sperm cryopreservation cost effective in the era of assisted reproductive technology? Urol Oncol 2018; 36:92.e1-92.e9. [DOI: 10.1016/j.urolonc.2017.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/27/2017] [Accepted: 11/06/2017] [Indexed: 12/20/2022]
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Toxicities Associated with Cisplatin-Based Chemotherapy and Radiotherapy in Long-Term Testicular Cancer Survivors. Adv Urol 2018; 2018:8671832. [PMID: 29670654 PMCID: PMC5835297 DOI: 10.1155/2018/8671832] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/06/2017] [Indexed: 12/16/2022] Open
Abstract
Testicular cancer has become the paradigm of adult-onset cancer survivorship, due to the young age at diagnosis and 10-year relative survival of 95%. This clinical review presents the current status of various treatment-related complications experienced by long-term testicular cancer survivors (TCS) free of disease for 5 or more years after primary treatment. Cardiovascular disease and second malignant neoplasms represent the most common potentially life-threatening late effects. Other long-term adverse outcomes include neuro- and ototoxicity, pulmonary complications, nephrotoxicity, hypogonadism, infertility, and avascular necrosis. Future research efforts should focus on delineation of the genetic underpinning of these long-term toxicities to understand their biologic basis and etiopathogenetic pathways, with the goal of developing targeted prevention and intervention strategies to optimize risk-based care and minimize chronic morbidities. In the interim, health care providers should advise TCS to adhere to national guidelines for the management of cardiovascular disease risk factors, as well as to adopt behaviors consistent with a healthy lifestyle, including smoking cessation, a balanced diet, and a moderate to vigorous intensity exercise program. TCS should also follow national guidelines for cancer screening as currently applied to the general population.
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Paoli D, Pallotti F, Lenzi A, Lombardo F. Fatherhood and Sperm DNA Damage in Testicular Cancer Patients. Front Endocrinol (Lausanne) 2018; 9:506. [PMID: 30271379 PMCID: PMC6146098 DOI: 10.3389/fendo.2018.00506] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/13/2018] [Indexed: 01/28/2023] Open
Abstract
Testicular cancer (TC) is one of the most treatable of all malignancies and the management of the quality of life of these patients is increasingly important, especially with regard to their sexuality and fertility. Survivors must overcome anxiety and fears about reduced fertility and possible pregnancy-related risks as well as health effects in offspring. There is thus a growing awareness of the need for reproductive counseling of cancer survivors. Studies found a high level of sperm DNA damage in TC patients in comparison with healthy, fertile controls, but no significant difference between these patients and infertile patients. Sperm DNA alterations due to cancer treatment persist from 2 to 5 years after the end of the treatment and may be influenced by both the type of therapy and the stage of the disease. Population studies reported a slightly reduced overall fertility of TC survivors and a more frequent use of ART than the general population, with a success rate of around 50%. Paternity after a diagnosis of cancer is an important issue and reproductive potential is becoming a major quality of life factor. Sperm chromatin instability associated with genome instability is the most important reproductive side effect related to the malignancy or its treatment. Studies investigating the magnitude of this damage could have a considerable translational importance in the management of cancer patients, as they could identify the time needed for the germ cell line to repair nuclear damage and thus produce gametes with a reduced risk for the offspring.
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37
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Hamano I, Hatakeyama S, Ohyama C. Fertility preservation of patients with testicular cancer. Reprod Med Biol 2017; 16:240-251. [PMID: 29259474 PMCID: PMC5715882 DOI: 10.1002/rmb2.12037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/10/2017] [Indexed: 11/23/2022] Open
Abstract
Background Testicular cancer (TC) is one of the most common malignancies in young men of reproductive age. Although TC is a curable malignancy with a high survival rate, its treatment requires various cytotoxic modalities and negatively impacts spermatogenesis; therefore, the fertility preservation of patients with TC has been studied. Methods In order to give an overview of fertility preservation in patients with TC, the literature was reviewed. Original and review articles were identified and examined on the basis of PubMed database searches. Results Chemotherapy and radiotherapy damage spermatogenesis and retroperitoneal lymph node dissection negatively impacts ejaculatory function. Testicular sperm extraction facilitates successful sperm retrieval in patients with TC with postchemotherapy azoospermia. Although preserved sperm is used with a very low frequency (8%), the conception rates in those who have used sperm are not inferior. Conclusion The number of studies is limited, and because numerous treatment factors affect fertility, outstanding questions remain about preserving the fertility of patients with TC. Further studies are necessary in order to determine the best means of preventing and treating infertility in patients with TC.
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Affiliation(s)
- Itsuto Hamano
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Shingo Hatakeyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Chikara Ohyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiJapan
- Department of Advanced Transplant and Regenerative MedicineHirosaki University Graduate School of MedicineHirosakiJapan
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Rives N, Walschaerts M, Setif V, Hennebicq S, Saias J, Brugnon F, Auger J, Berthaut I, Szerman E, Daudin M, Bujan L. Sperm aneuploidy after testicular cancer treatment: data from a prospective multicenter study performed within the French Centre d’Étude et de Conservation des Oeufs et du Sperme network. Fertil Steril 2017; 107:580-588.e1. [DOI: 10.1016/j.fertnstert.2016.11.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 01/04/2023]
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Bogefors K, Giwercman YL, Eberhard J, Stahl O, Cavallin-Stahl E, Cohn-Cedermark G, Arver S, Giwercman A. Androgen receptor gene CAG and GGN repeat lengths as predictors of recovery of spermatogenesis following testicular germ cell cancer treatment. Asian J Androl 2016; 19:538-542. [PMID: 27873769 PMCID: PMC5566846 DOI: 10.4103/1008-682x.191126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Spermatogenesis is an androgen-regulated process that depends on the action of androgen receptor (AR). Sperm production may be affected in men treated for testicular cancer (TC), and it is important to identify the factors influencing the timing of spermatogenesis recovery following cancer treatment. It is known that the CAG and GGN repeat numbers affect the activity of the AR; therefore, the aim of this study is to investigate if the CAG and GGN polymorphisms in the AR gene predict recovery of sperm production after TC treatment. TC patients (n = 130) delivered ejaculates at the following time points: postorchiectomy and at 6, 12, 24, 36, and 60 months posttherapy (T0, T6, T12, T24, T36, and T60). The CAG lengths were categorized into three groups, <22 CAG, 22–23 CAG, and >23 CAG, and the GGN tracts were also categorized into three groups, <23 GGN, 23 GGN, and >23 GGN. At T12, men with 22–23 CAG presented with a statistically significantly (P = 0.045) lower sperm concentration than those with other CAG numbers (8.4 × 106 ml−1vs 16 × 106 ml−1; 95% CI: 1.01–2.65). This association was robust to omitting adjustment for treatment type and sperm concentration at T0 (P = 0.021; 3.7 × 106 ml−1vs 10 × 106 ml−1; 95% CI: 1.13–4.90). The same trends were observed for total sperm number. The least active AR variant seems to be associated with a more rapid recovery of spermatogenesis. This finding adds to our understanding of the biology of postcancer therapy recovery of fertility in males and has clinical implications.
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Affiliation(s)
- Karolina Bogefors
- Reproductive Medicine Centre, Skane University Hospital, Malmö, Sweden.,Department of Oncology, Skane University Hospital, Malmö, Sweden
| | | | - Jakob Eberhard
- Department of Oncology, Skane University Hospital, Lund, Sweden
| | - Olof Stahl
- Department of Oncology, Skane University Hospital, Lund, Sweden
| | | | | | - Stefan Arver
- Centre of Andrology and Sexual Medicine, Karolinska Hospital, Stockholm, Sweden
| | - Aleksander Giwercman
- Reproductive Medicine Centre, Skane University Hospital, Malmö, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
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Namekawa T, Imamoto T, Kato M, Sazuka T, Fuse M, Sakamoto S, Kawamura K, Ichikawa T. Testicular function among testicular cancer survivors treated with cisplatin-based chemotherapy. Reprod Med Biol 2016; 15:175-181. [PMID: 29259434 PMCID: PMC5715851 DOI: 10.1007/s12522-015-0232-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022] Open
Abstract
Purpose The aim of our study was to identify the clinical predictors of spermatogenesis recovery in testicular cancer (TC) patients after chemotherapy and to determine the recuperation period for spermatogenesis. Methods Patients treated for TC from January 1982 to November 2001 at Chiba University Hospital were retrospectively assessed. Thirty-five patients who met the following criteria were examined-(i) underwent both high orchiectomy and cisplatin-based chemotherapy; (ii) had semen analyses and hormonal measurements; and (iii) were alive with no evidence of disease. Clinical variables associated with normalization of spermatogenesis after chemotherapy were examined. Time to recover normospermia was also evaluated using Kaplan-Meier analysis. Results The observation period was 13.3 ± 5.6 years. Reappearance of sperm was confirmed in 85.7 % of patients, and 54.3 % of patients recovered normospermia. Age at diagnosis <25 years (p = 0.0057), number of chemotherapy cycles <4 cycles (p = 0.0042), and follicle-stimulating hormone at the end of chemotherapy <18 mIU/ml (p = 0.0220) were independent factors related to post-chemotherapy normalization of semen findings. The median (95 % CI) time to recover normospermia was 40 (range 22-96) months. Conclusions These findings help to predict whether spermatogenesis will recover and its timing. They may also help clinicians identify and manage TC patients at a higher risk of prolonged azoospermia after chemotherapy.
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Affiliation(s)
- Takeshi Namekawa
- Department of UrologyGraduate School of Medicine, Chiba University1‐8‐1 Inohana‐cho, Chuo‐ku260‐8670ChibaJapan
| | - Takashi Imamoto
- Department of UrologyGraduate School of Medicine, Chiba University1‐8‐1 Inohana‐cho, Chuo‐ku260‐8670ChibaJapan
| | - Mayuko Kato
- Department of UrologyGraduate School of Medicine, Chiba University1‐8‐1 Inohana‐cho, Chuo‐ku260‐8670ChibaJapan
| | - Tomokazu Sazuka
- Department of UrologyGraduate School of Medicine, Chiba University1‐8‐1 Inohana‐cho, Chuo‐ku260‐8670ChibaJapan
| | - Miki Fuse
- Department of UrologyGraduate School of Medicine, Chiba University1‐8‐1 Inohana‐cho, Chuo‐ku260‐8670ChibaJapan
| | - Shinichi Sakamoto
- Department of UrologyGraduate School of Medicine, Chiba University1‐8‐1 Inohana‐cho, Chuo‐ku260‐8670ChibaJapan
| | - Koji Kawamura
- Department of UrologyGraduate School of Medicine, Chiba University1‐8‐1 Inohana‐cho, Chuo‐ku260‐8670ChibaJapan
| | - Tomohiko Ichikawa
- Department of UrologyGraduate School of Medicine, Chiba University1‐8‐1 Inohana‐cho, Chuo‐ku260‐8670ChibaJapan
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Wang L, Peng J, Huang H, Wang Q, Yu M, Tao L. Simvastatin protects Sertoli cells against cisplatin cytotoxicity through enhanced gap junction intercellular communication. Oncol Rep 2015; 34:2133-41. [PMID: 26260290 DOI: 10.3892/or.2015.4192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/09/2015] [Indexed: 11/06/2022] Open
Abstract
Cisplatin, an important chemotherapeutic agent against testicular germ cell cancer, induces testicular toxicity on Leydig and Sertoli cells, leading to serious side-effects such as azoospermia and infertility. In a previous study, it was found that simvastatin enhanced the sensitivity of Leydig tumor cells to chemotherapeutic toxicity through the enhancement of gap junction functions. In the present study, the effect of simvastatin on the sensitivity of normal Sertoli cells to cisplatin and the role of gap junctions in such effects was investigated. The results showed that, simvastatin attenuated cisplatin toxicity only when cells exhibited high-density culture where gap junctional formation was possible. When gap junction function was decreased by the gap junction inhibitor or by siRNA targeting connexin 43, the protective effect of simvastatin to cisplatin toxicity was substantially attenuated. Simvastatin also enhanced gap junction functions between Sertoli cells. This effect was mediated by the reduction of PKC-mediated connexin phosphorylation, thereby increasing connexin 43 membrane localization. Thus, simvastatin-induced enhancement of gap junction‑mediated intercellular communication attenuated cisplatin toxicity on Sertoli cells. This result indicated that enhancement of gap junction function by simvastatin may have bilateral beneficial effects on cisplatin‑based chemotherapy, enhancing cisplatin killing on cancer while ameliorating the reproduction toxicity.
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Affiliation(s)
- Lingzhi Wang
- Department of Anaesthesia, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, P.R. China
| | - Jianxin Peng
- Department of Hepatobiliary Surgery, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou 510120, P.R. China
| | - Huansen Huang
- Department of Anaesthesia, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, P.R. China
| | - Qin Wang
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou 510080, P.R. China
| | - Meiling Yu
- Department of Pharmacy, The First Affiliated Hospital, Bengbu Medical College, Bengbu, Anhui 233004, P.R. China
| | - Liang Tao
- Department of Pharmacology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou 510080, P.R. China
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Oldenburg J, Cullen M, Tandstad T. Primum non nocere: do we harm stage I testicular cancer patients less by applying adjuvant chemotherapy than by failing to present this option? Ann Oncol 2015; 26:255-6. [DOI: 10.1093/annonc/mdu520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oldenburg J, Aparicio J, Beyer J, Cohn-Cedermark G, Cullen M, Gilligan T, De Giorgi U, De Santis M, de Wit R, Fosså SD, Germà-Lluch JR, Gillessen S, Haugnes HS, Honecker F, Horwich A, Lorch A, Ondruš D, Rosti G, Stephenson AJ, Tandstad T. Personalizing, not patronizing: the case for patient autonomy by unbiased presentation of management options in stage I testicular cancer. Ann Oncol 2014; 26:833-838. [PMID: 25378299 DOI: 10.1093/annonc/mdu514] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/28/2014] [Indexed: 11/12/2022] Open
Abstract
Testicular cancer (TC) is the most common neoplasm in males aged 15-40 years. The majority of patients have no evidence of metastases at diagnosis and thus have clinical stage I (CSI) disease [Oldenburg J, Fossa SD, Nuver J et al. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24(Suppl 6): vi125-vi132; de Wit R, Fizazi K. Controversies in the management of clinical stage I testis cancer. J Clin Oncol 2006; 24: 5482-5492.]. Management of CSI TC is controversial and options include surveillance and active treatment. Different forms of adjuvant therapy exist, including either one or two cycles of carboplatin chemotherapy or radiotherapy for seminoma and either one or two cycles of cisplatin-based chemotherapy or retroperitoneal lymph node dissection for non-seminoma. Long-term disease-specific survival is ∼99% with any of these approaches, including surveillance. While surveillance allows most patients to avoid additional treatment, adjuvant therapy markedly lowers the relapse rate. Weighing the net benefits of surveillance against those of adjuvant treatment depends on prioritizing competing aims such as avoiding unnecessary treatment, avoiding more burdensome treatment with salvage chemotherapy and minimizing the anxiety, stress and life disruption associated with relapse. Unbiased information about the advantages and disadvantages of surveillance and adjuvant treatment is a prerequisite for informed consent by the patient. In a clinical scenario like CSI TC, where different disease-management options produce indistinguishable long-term survival rates, patient values, priorities and preferences should be taken into account. In this review, we provide an overview about risk factors for relapse, potential benefits and harms of adjuvant chemotherapy and active surveillance and a rationale for involving patients in individualized decision making about their treatment rather than adopting a uniform recommendation for all.
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Affiliation(s)
- J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Department of Oncology, University of Oslo, Oslo, Norway.
| | - J Aparicio
- Department of Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J Beyer
- Department of Oncology, Universitätsspital Zürich, Zürich, Switzerland
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - M Cullen
- Department of Medical Oncology, Queen Elizabeth Hospital, University Hospital Birmingham Foundation Trust, Birmingham, UK
| | - T Gilligan
- Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, USA
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - M De Santis
- Kaiser Franz Josef Hospital and ACR-ITR and LBI-ACR Vienna-CTO, Vienna, Austria
| | - R de Wit
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S D Fosså
- Department of Oncology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - J R Germà-Lluch
- Department of Oncology, Institut Català d'Oncologia, Gran Via de l'Hospitalet Hospitalet de Llobregat, Barcelona, Spain
| | - S Gillessen
- Department of Medical Oncology, Kantonsspital, St Gallen, Switzerland
| | - H S Haugnes
- Oncology Department, University Hospital of North Norway, Tromsø, Norway
| | - F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland
| | - A Horwich
- Department of Clinical Oncology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - A Lorch
- Klinik für Urologie, konservative Uroonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - D Ondruš
- Department of Oncology, Comenius University Faculty of Medicine, St Elisabeth Cancer Institute, Bratislava, Slovak Republic
| | - G Rosti
- Medical Oncology, Ospedale Generale, Treviso, Italy
| | | | - T Tandstad
- The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
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45
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Cohn-Cedermark G, Stahl O, Tandstad T. Surveillance vs. adjuvant therapy of clinical stage I testicular tumors - a review and the SWENOTECA experience. Andrology 2014; 3:102-10. [DOI: 10.1111/andr.280] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/26/2014] [Accepted: 08/30/2014] [Indexed: 01/22/2023]
Affiliation(s)
- G. Cohn-Cedermark
- Department of Oncology-Pathology; Karolinska Institute; Stockholm Sweden
- Karolinska University Hospital; Stockholm Sweden
| | - O. Stahl
- Department of Oncology; Skane University Hospital; Lund Sweden
| | - T. Tandstad
- The Cancer Clinic; St. Olavs University Hospital; Trondheim Norway
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46
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Effects of combined treatment of α-tocopherol, l-ascorbic acid, selenium and zinc on bleomycin, etoposide and cisplatin-induced alterations in testosterone synthesis pathway in rats. Cancer Chemother Pharmacol 2014; 74:1175-89. [DOI: 10.1007/s00280-014-2592-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
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Tandstad T, Ståhl O, Håkansson U, Dahl O, Haugnes HS, Klepp OH, Langberg CW, Laurell A, Oldenburg J, Solberg A, Söderström K, Cavallin-Ståhl E, Stierner U, Wahlquist R, Wall N, Cohn-Cedermark G. One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded results from the SWENOTECA group. Ann Oncol 2014; 25:2167-2172. [PMID: 25114021 DOI: 10.1093/annonc/mdu375] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND SWENOTECA has since 1998 offered patients with clinical stage I (CS I) nonseminoma, adjuvant chemotherapy with one course of bleomycin, etoposide and cisplatin (BEP). The aim has been to reduce the risk of relapse, sparing patients the need of toxic salvage treatment. Initial results on 312 patients treated with one course of adjuvant BEP, with a median follow-up of 4.5 years, have been previously published. We now report mature and expanded results. PATIENTS AND METHODS In a prospective, binational, population-based risk-adapted treatment protocol, 517 Norwegian and Swedish patients with CS I nonseminoma received one course of adjuvant BEP. Patients with lymphovascular invasion (LVI) in the primary testicular tumor were recommended one course of adjuvant BEP. Patients without LVI could choose between surveillance and one course of adjuvant BEP. Data for patients receiving one course of BEP are presented in this study. RESULTS At a median follow-up of 7.9 years, 12 relapses have occurred, all with IGCCC good prognosis. The latest relapse occurred 3.3 years after adjuvant treatment. The relapse rate at 5 years was 3.2% for patients with LVI and 1.6% for patients without LVI. Five-year cause-specific survival was 100%. CONCLUSIONS The updated and expanded results confirm a low relapse rate following one course of adjuvant BEP in CS I nonseminoma. One course of adjuvant BEP should be considered a standard treatment in CS I nonseminoma with LVI. For patients with CS I nonseminoma without LVI, one course of adjuvant BEP is also a treatment option.
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Affiliation(s)
- T Tandstad
- The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway.
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund
| | - U Håkansson
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - O Dahl
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen; Haukeland University Hospital, Bergen
| | - H S Haugnes
- Institute of Clinical Medicine, University of Tromsø, Tromsø; University Hospital of North Norway, Tromsø
| | - O H Klepp
- Department of Oncology, Ålesund Hospital, Ålesund
| | - C W Langberg
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A Laurell
- Department of Oncology, Uppsala University Hospital, Uppsala
| | - J Oldenburg
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A Solberg
- The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - K Söderström
- The Cancer Clinic, Norrland University Hospital, Umeå
| | | | - U Stierner
- Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - R Wahlquist
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - N Wall
- Institute of Clinical and Experimental Medicine, University of Linköping, Linköping
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
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Isaksson S, Eberhard J, Ståhl O, Cavallin-Ståhl E, Cohn-Cedermark G, Arver S, Lundberg Giwercman Y, Giwercman A. Inhibin B concentration is predictive for long-term azoospermia in men treated for testicular cancer. Andrology 2014; 2:252-8. [DOI: 10.1111/j.2047-2927.2014.00182.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/20/2013] [Accepted: 12/28/2013] [Indexed: 01/15/2023]
Affiliation(s)
- S. Isaksson
- Reproductive Medicine Centre; Skåne University Hospital; Malmö Sweden
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | - J. Eberhard
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | - O. Ståhl
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | | | - G. Cohn-Cedermark
- Department of Oncology; Karolinska Institutet and University Hospital; Stockholm Sweden
| | - S. Arver
- Centre for Andrology and Sexual Medicine; Karolinska University Hospital; Stockholm Sweden
- Department of Medicine; Karolinska Institutet; Stockholm Sweden
| | | | - A. Giwercman
- Reproductive Medicine Centre; Skåne University Hospital; Malmö Sweden
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49
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Kilarkaje N, Mousa AM, Al-Bader MM, Khan KM. Antioxidants enhance the recovery of three cycles of bleomycin, etoposide, and cisplatin–induced testicular dysfunction, pituitary-testicular axis, and fertility in rats. Fertil Steril 2013; 100:1151-9. [DOI: 10.1016/j.fertnstert.2013.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/20/2013] [Accepted: 06/10/2013] [Indexed: 11/26/2022]
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50
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Brydøy M, Fosså SD, Klepp O, Bremnes RM, Wist EA, Bjøro T, Wentzel-Larsen T, Dahl O. Sperm counts and endocrinological markers of spermatogenesis in long-term survivors of testicular cancer. Br J Cancer 2013; 107:1833-9. [PMID: 23169336 PMCID: PMC3504949 DOI: 10.1038/bjc.2012.471] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: The objective of this study was to assess markers of spermatogenesis in long-term survivors of testicular cancer (TC) according to treatment, and to explore correlations between the markers and associations with achieved paternity following TC treatment. Methods: In 1191 TC survivors diagnosed between 1980 and 1994, serum-follicle stimulating hormone (s-FSH; n=1191), s-inhibin B (n=441), and sperm counts (millions per ml; n=342) were analysed in a national follow-up study in 1998–2002. Paternity was assessed by a questionnaire. Results: At median 11 years follow-up, 44% had oligo- (<15 millions per ml; 29%) or azoospermia (15%). Sperm counts and s-inhibin B were significantly lower and s-FSH was higher after chemotherapy, but not after radiotherapy (RT), when compared with surgery only. All measures were significantly more abnormal following high doses of chemotherapy (cisplatin (Cis)>850 mg, absolute cumulative dose) compared with lower doses (Cis ⩽850 mg). Sperm counts were moderately correlated with s-FSH (−0.500), s-inhibin B (0.455), and s-inhibin B : FSH ratio (−0.524; all P<0.001). All markers differed significantly between those who had achieved post-treatment fatherhood and those with unsuccessful attempts. Conclusion: The RT had no long-term effects on the assessed markers of spermatogenesis, whereas chemotherapy had. At present, the routine evaluation of s-inhibin B adds little in the initial fertility evaluation of TC survivors.
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Affiliation(s)
- M Brydøy
- Section of Oncology, Institute of Medicine, University of Bergen, Bergen N-5021, Norway.
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