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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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Tufano A, Cilio S, Spena G, Izzo A, Castaldo L, Grimaldi G, Muscariello R, Franzese D, Quarto G, Autorino R, Passaro F, Perdonà S. Unilateral Post-Chemotherapy Robot-Assisted Retroperitoneal Lymph Node Dissection for Stage II Non-Seminomatous Germ Cell Tumors: Sexual and Reproductive Outcomes. Cancers (Basel) 2024; 16:2231. [PMID: 38927936 PMCID: PMC11201837 DOI: 10.3390/cancers16122231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
We aimed to report sexual and reproductive outcomes following post-chemotherapy robot-assisted retroperitoneal unilateral lymph node dissection (PC-rRPLND) for non-seminomatous germ cell tumors (NSGCTs) at a high-volume cancer center. We collected records regarding sexual and reproductive outcomes of patients undergoing unilateral PC-rRPLND for stage II NSGCTs from January 2018 to November 2021. Preoperative and postoperative (at 12 months) ejaculatory function as well as erectile function, based on the International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Score (EHS), were assessed. Only patients with a pre-operative IIEF-5 of ≥22 and EHS of ≥3 were included in this analysis. Overall, 22 patients undergoing unilateral PC-rRPLND met the inclusion criteria. Of these, seven (31.8%) patients presented an andrological disorder of any type after PC-rRPLND. Specifically, retrograde ejaculation was present in three (13.6%) patients and hypospermia was present in one (4.5%) patient. Moreover, three (13.6%) patients yielded erectile dysfunction (IIEF-5 < 22 and/or EHS < 3). Lastly, two (9.1%) succeeded in naturally conceiving a child after PC-rRPLND. Retrograde ejaculation is confirmed to be one of the most common complications of PC-rRPLND. Moreover, a non-negligible number of patients experience erectile dysfunction.
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Affiliation(s)
- Antonio Tufano
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” Rome University, 00161 Rome, Italy
| | - Simone Cilio
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Gianluca Spena
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Alessandro Izzo
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Luigi Castaldo
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Giovanni Grimaldi
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Raffaele Muscariello
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Dario Franzese
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Giuseppe Quarto
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Francesco Passaro
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Sisto Perdonà
- Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale”, Via M. Semmola, 80131 Naples, Italy (A.I.); (D.F.); (S.P.)
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Kanthabalan A, Emmanuel A, Alexander C, Bhatt N, Chan V, Kalejaiye O, Narahari K, Kasivisvanathan V, Shabbir M. An international survey of contemporary practices towards fertility assessment and preservation in patients undergoing radical inguinal orchidectomy for testicular cancer. BJUI COMPASS 2024; 5:445-453. [PMID: 38751948 PMCID: PMC11090774 DOI: 10.1002/bco2.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 05/18/2024] Open
Abstract
Objective The study aims to assess current international clinician attitudes, practices and barriers towards fertility assessment and preservation in patients undergoing radical inguinal orchidectomy (RIO) for testicular cancer. Materials and methods An international online survey of urologists and urologists in training who perform RIO for testicular cancer was developed by the British Association of Urological Surgeons (BAUS) Sections of Andrology and Oncology and the British Urology Researchers in Surgical Training (BURST). The recruitment process used social media and the emailing lists of national urological societies. Responses were collected between 10/02/2021 and 31/05/2021 and stored using password-protected Research Electronic Data Capture (REDCap) database software. The primary outcome was the proportion of urologists who routinely offer semen cryopreservation prior to RIO. The study was reported according to the Checklist for Reporting Results of Internet E-Surveys platform. Results A total of 393 respondents took part in the online survey; of these, the majority were from the United Kingdom (65.9%), with the remaining international respondents (34.1%) from six different continents, which included 45 different countries. Of the respondents, 57.1% reported that they would routinely offer semen cryopreservation to all patients undergoing RIO for testicular cancer. In addition, 36.0% of urologists routinely performed pre-operative semen analysis, and 22.1% routinely performed pre-operative testicular serum hormone profile. Of the respondents, 14.4% performed expedited RIO within 48 h; 31.2% of respondents reported that they considered no delay to RIO to allow for semen cryopreservation to be acceptable. Conclusions A significant proportion of international urologists do not offer pre-operative fertility assessment and preservation in men undergoing RIO for testicular cancer. Surgery is performed in an expedited fashion within 1 week in the majority of patients. Urologists perceive there to be a lack of access and availability to fertility services, and that delay to RIO to allow for fertility preservation is often not acceptable.
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Affiliation(s)
- Abi Kanthabalan
- Department of UrologyWorcestershire Royal HospitalWorcesterUK
| | | | | | - Nikita Bhatt
- Department of UrologyNorfolk and Norwich University HospitalNorwichUK
| | - Vinson Chan
- School of Medicine, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Odunayo Kalejaiye
- Department of UrologyUniversity Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - Krishna Narahari
- Department of UrologyCardiff and Vale University Health BoardCardiffUK
| | - Veeru Kasivisvanathan
- Department of UrologyUniversity Hospitals Bristol and Weston NHS Foundation TrustBristolUK
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
| | - Majid Shabbir
- Department of UrologyGuy's & St. Thomas' HospitalLondonUK
- Faculty of Life Sciences & MedicineKing's CollegeLondon
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Tsujioka H, Uemura KI, Osaka A, Iwahata T, Fujii A, Ban S, Okada H, Saito K. Two tumor types in a unilateral testis in a patient with severe oligozoospermia and a history of cryptorchidism surgery: A case report. Oncol Lett 2024; 27:130. [PMID: 38348386 PMCID: PMC10859824 DOI: 10.3892/ol.2024.14262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/27/2023] [Indexed: 02/15/2024] Open
Abstract
Testicular cancer, the most common cancer among young male adults, is associated with infertility. A 38-year-old male patient was admitted to Dokkyo Medical University Saitama Medical Center, Japan, with infertility associated with severe oligozoospermia. Scrotal ultrasonography revealed two distinct tumors in the left testis: A mass with abundant blood flow on the cranial side and a mass with poor blood flow on the caudal side. Additional analysis revealed mild elevation of intact human chorionic gonadotropin (hCG) levels (tumor marker level assessment), high testosterone and low luteinizing hormone and follicle-stimulating hormone levels (hormonal level assessment) and severe oligoasthenozoospermia (semen assessment). The preoperative diagnosis was left-sided testicular cancer and severe oligoasthenozoospermia and the patient underwent left high orchiectomy and oncological testicular sperm extraction. Based on the pathological assessment, the cranial tumor was diagnosed as a seminoma with syncytiotrophoblastic cells, whereas the caudal tumor had only scar tissue with germ cell neoplasia in situ in the adjacent parenchyma. Following surgery, intact hCG and hormone levels of the patient were normalized, and the semen parameters (semen volume, sperm density, and motility) improved dramatically. To the best of our knowledge, the present case is the first report of two types of testicular tumor in a unilateral testis in a patient with a history of cryptorchidism surgery. The present case demonstrated that scrotal ultrasonography should be performed in patients with abnormal semen results to rule out testicular tumors.
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Affiliation(s)
- Hiroki Tsujioka
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Kei-Ichiro Uemura
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
- Department of Urology, School of Medicine, Kurume University, Kurume, Fukuoka 830-0011, Japan
| | - Akiyoshi Osaka
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Toshiyuki Iwahata
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Akiko Fujii
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Shinichi Ban
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Hiroshi Okada
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
| | - Kazutaka Saito
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama 343-8555, Japan
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Mendes G, Teixeira B, Madanelo M, Rocha A, Mesquita S, Vital J, Monteiro M, Fraga A, Louro N. Semen parameters in testicular tumor patients before orchiectomy: What is the impact of testicular tumor stage and histology? Arch Ital Urol Androl 2024; 96:12238. [PMID: 38389451 DOI: 10.4081/aiua.2024.12238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOSE To evaluate the influence of testicular cancer histology and stage on sperm parameters in cryopreserved samples collected prior to orchiectomy. MATERIALS AND METHODS We conducted a retrospective analysis of tumor histology, stage and sperm parameters of patients who underwent pre-orchiectomy sperm cryopreservation for testicular cancer between March 2010 and March 2023. The World Health Organization (WHO) 2010 sperm reference values were used to identify patients with subnormal semen parameters and to further categorize patients by sperm alteration. Localized disease was classified as Stage I, while metastatic disease encompassed Stages II and III. Continuous variables were compared using t-test or Mann Whitney U test, and categorical variables using Chi-square and Fishers exact test. RESULTS A total of 64 patients was identified, 48 (75%) classified as stage I and 16 (25%) classified as stage II/III. No difference was found in semen parameters between patients with seminoma and patients with non-seminoma germ cell tumor (NSGCT). Patients with stage II/III disease had significantly lower percentages of progressive motility (36% vs 53%, p=0.021) and total motility (60% vs 69%, p=0.015) than stage I patients. When categorizing by sperm alterations according to WHO 2010 reference values, patients with stage II/III disease had significantly higher proportions of asthenozoospermia (38% vs 15%, p=0.048) and teratozoospermia (63% vs 31%, p=0.027) than stage I patients. Elevated tumor markers were not associated with sperm abnormalities. CONCLUSIONS Patients with metastatic testicular cancer present with worse sperm quality than patients with localized disease. Sperm cryopreservation should be offered to all patients with testicular cancer, and especially emphasized in patients with metastatic disease.
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Affiliation(s)
- Gonçalo Mendes
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Bernardo Teixeira
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Mariana Madanelo
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Alexandra Rocha
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Sofia Mesquita
- Department of Urology, Santo António University Hospital Center, Porto.
| | - João Vital
- Department of Urology, Hospital of Funchal.
| | - Miguel Monteiro
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Avelino Fraga
- Department of Urology, Santo António University Hospital Center, Porto.
| | - Nuno Louro
- Department of Urology, Santo António University Hospital Center, Porto.
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Törzsök P, Oswald D, Dieckmann KP, Angerer M, Scherer LC, Tymoszuk P, Kunz Y, Pinggera GM, Lusuardi L, Horninger W, Pichler R. Subsets of preoperative sex hormones in testicular germ cell cancer: a retrospective multicenter study. Sci Rep 2023; 13:14604. [PMID: 37669975 PMCID: PMC10480169 DOI: 10.1038/s41598-023-41915-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/04/2023] [Indexed: 09/07/2023] Open
Abstract
Preoperative homeostasis of sex hormones in testicular germ cell tumor (TGCT) patients is scarcely characterized. We aimed to explore regulation of sex hormones and their implications for histopathological parameters and prognosis in TGCT using a data-driven explorative approach. Pre-surgery serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), estradiol (E2) and prolactin were measured in a retrospective multicenter TGCT cohort (n = 518). Clusters of patients were defined by latent class analysis. Clinical, pathologic and survival parameters were compared between the clusters by statistical hypothesis testing, Random Forest modeling and Peto-Peto test. Cancer tissue expression of sex hormone-related genes was explored in the publicly available TCGA cohort (n = 149). We included 354 patients with pure seminoma and 164 patients with non-seminomatous germ cell tumors (NSGCT), with a median age of 36 years. Three hormonal clusters were defined: 'neutral' (n = 228) with normal sex hormone homeostasis, 'testicle' (n = 91) with elevated T and E2, low pituitary hormones, and finally 'pituitary' subset (n = 103) with increased FSH and LH paralleled by low-to-normal levels of the gonadal hormones. Relapse-free survival in the hormonal subsets was comparable (p = 0.64). Cancer tissue expression of luteinizing hormone- and follicle-stimulating hormone-coding genes was significantly higher in seminomas, while genes of T and E2 biosynthesis enzymes were strongly upregulated in NSGCT. Substantial percentages of TGCT patients are at increased risk of sex hormone dysfunction at primary diagnosis before orchiectomy. TGCT may directly influence systemic hormonal homeostasis by in-situ synthesis of sex hormones.
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Affiliation(s)
- Péter Törzsök
- Department of Urology and Andrology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - David Oswald
- Department of Urology and Andrology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Markus Angerer
- Department of Urology, Hodentumorzentrum, Asklepios Klinik Altona, Hamburg, Germany
| | - Lukas Christian Scherer
- Department of Urology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Yannic Kunz
- Department of Urology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Germar-Michael Pinggera
- Department of Urology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Lukas Lusuardi
- Department of Urology and Andrology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Wolfgang Horninger
- Department of Urology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Comprehensive Cancer Center Innsbruck (CCCI), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Maiolino G, Fernández-Pascual E, Ochoa Arvizo MA, Vishwakarma R, Martínez-Salamanca JI. Male Infertility and the Risk of Developing Testicular Cancer: A Critical Contemporary Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1305. [PMID: 37512119 PMCID: PMC10383207 DOI: 10.3390/medicina59071305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The relationship between male infertility (MI) and testicular cancer (TC) is bilateral. On one hand, it is well-established that patients diagnosed with TC have a high risk of pre- and post-treatment infertility. On the other hand, the risk of developing TC in male infertile patients is not clearly defined. The objective of this review is to analyze the histopathological, etiological, and epidemiological associations between MI and the risk of developing testicular cancer. This review aims to provide further insights and offer a guide for assessing the risk factors for TC in infertile men. Materials and Methods: A comprehensive literature search was conducted to identify relevant studies discussing the relationship between MI and the risk of developing TC. Results: The incidence rates of germ cell neoplasia in situ (GCNIS) appear to be high in infertile men, particularly in those with low sperm counts. Most epidemiological studies have found a statistically significant risk of developing TC among infertile men compared to the general or fertile male populations. The concept of Testicular Dysgenesis Syndrome provides an explanatory model for the common etiology of MI, TC, cryptorchidism, and hypospadias. Clinical findings such as a history of cryptorchidism could increase the risk of developing TC in infertile men. Scrotal ultrasound evaluation for testis lesions and microlithiasis is important in infertile men. Sperm analysis parameters can be useful in assessing the risk of TC among infertile men. In the future, sperm and serum microRNAs (miRNAs) may be utilized for the non-invasive early diagnosis of TC and GCNIS in infertile men. Conclusions: MI is indeed a risk factor for developing testicular cancer, as demonstrated by various studies. All infertile men should undergo a risk assessment using clinical examination, ultrasound, and semen parameters to evaluate their risk of TC.
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Affiliation(s)
- Giuseppe Maiolino
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129 Perugia, Italy
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Esaú Fernández-Pascual
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Urology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Mario Alberto Ochoa Arvizo
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, 28222 Madrid, Spain
| | - Ranjit Vishwakarma
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Juan Ignacio Martínez-Salamanca
- LYX Institute of Urology, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, 28222 Madrid, Spain
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Cirigliano L, Falcone M, Gül M, Preto M, Ceruti C, Plamadeala N, Peretti F, Ferro I, Scavone M, Gontero P. Onco-TESE (Testicular Sperm Extraction): Insights from a Tertiary Center and Comprehensive Literature Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1226. [PMID: 37512038 PMCID: PMC10386487 DOI: 10.3390/medicina59071226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The peak of incidence of testicular cancer (TC) occurs among individuals in their reproductive age, emphasizing the importance of fertility preservation as an integral aspect of disease management. Sperm cryopreservation performed before orchiectomy is ineffective in azoospermic men, necessitating alternative approaches such as microdissection testicular sperm extraction (mTESE) at the time of orchiectomy (onco-mTESE) to obtain viable sperm. This study presents the findings from our institution's experience with onco-mTESE and critically discusses our results in light of the existing body of literature. Materials and Methods: This is a tertiary center retrospective analysis of onco-mTESE procedures performed at a single center between December 2011 and July 2022. The included patients were post-puberal men with testicular tumors requiring orchiectomy, along with concomitant severe oligozoospermia or azoospermia. Bilateral mTESE was performed in all cases. Surgical outcomes, sperm retrieval rates, the usage of preserved viable sperm, assistive reproductive techniques' results, and post-operative serum testosterone were recorded. Results: A total of nine patients were included, with a median age of 34 (IQR 29-36) years. All patients had germ cell tumors (GCTs), with seminomatous and non-seminomatous GCTs accounting for 44.4% (n = 4) and 55.6% (n = 5) of patients, respectively. Sperm retrieval occurred in three (33%) patients: one patient in the ipsilateral testis, one in the contralateral testis, and one in both testes. No complications were reported during the procedure, and no post-operative hypogonadism was observed. Among the three patients with successful sperm retrieval, an intracytoplasmic sperm injection (ICSI) was performed in two patients, resulting in two pregnancies, leading to one healthy live birth and one miscarriage. Conclusions: In the context of TC, it is essential to conduct a thorough evaluation of testicular function, including a semen analysis and cryopreservation. Onco-mTESE has proven its safety in preserving fertility in azoospermic cases while ensuring the efficacy of oncological treatment.
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Affiliation(s)
- Lorenzo Cirigliano
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Marco Falcone
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
- Neurourology Clinic-A.O.U. "Città della Salute e della Scienza"-Unità Spinale Unipolare, 10100 Turin, Italy
| | - Murat Gül
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
- Department of Urology, School of Medicine, Selcuk University, Konya 42005, Turkey
| | - Mirko Preto
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Carlo Ceruti
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Natalia Plamadeala
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Federica Peretti
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Ilaria Ferro
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Martina Scavone
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
| | - Paolo Gontero
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, 10100 Turin, Italy
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9
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Shrem NS, Wood L, Hamilton RJ, Kuhathaas K, Czaykowski P, Roberts M, Matthew A, Izard JP, Chung P, Nappi L, Jones J, Soulières D, Aprikian A, Power N, Canil C. Testicular cancer survivorship: Long-term toxicity and management. Can Urol Assoc J 2022; 16:257-272. [PMID: 35905486 PMCID: PMC9343164 DOI: 10.5489/cuaj.8009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Noa Shani Shrem
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kopika Kuhathaas
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew Roberts
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jason P. Izard
- Departments of Urology and Oncology, Queen’s University, Kingston, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Health Network, University of Toronto, Toronto, ON, Canada
| | - Lucia Nappi
- Division of Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Le Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Armen Aprikian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Nicholas Power
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Christina Canil
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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10
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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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11
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Pang KH, Osman NI, Muneer A, Alnajjar HM. The relationship between testicular tumour characteristics and azoospermia: a systematic review. Int J Impot Res 2021; 34:543-551. [PMID: 34743192 DOI: 10.1038/s41443-021-00492-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 11/09/2022]
Abstract
Subfertility is a risk factor for testicular cancers (TT), and conversely, TT may induce subfertility due to local and regional toxic effects. We aimed to identify the association between TT characteristics and pre-orchidectomy azoospermia. A systematic review of the literature was performed according to the PRISMA checklist. Overall, eight non-randomised studies involving 469 men with TT (azoospermia, n = 57; no azoospermia n = 412) were included in the qualitative analysis. Bilateral TT (12.3% vs 2.9% in non-azoospermia), non-seminoma germ cell tumours (6.4% vs 1.9%), germ cell neoplasia in-situ (GCNIS) (11.1% vs 1.2%), stage 2-3 disease (22.2% vs 0%), Sertoli Cell only (SCO) on biopsy (60% vs 37.5%) and a history of undescended testis (UDT) (66.7% vs 50%) were more common in azoospermic men. FSH levels are higher (18.7-23.2 mIU/L vs <0.1-8 mIU/L in non-azoospermia), testosterone is lower, and testis size are smaller (lower range 1 mL vs 10 mL) in men with azoospermia. Leydig cell tumours and hyperplasia were only detected in men with azoospermia. In summary, bilateral TT, GCNIS, higher tumour stage, smaller testes, SCO and history of UDT may have direct effects on spermatogenesis. Small testis, raised FSH and low testosterone may reflect reduced testicular function in azoospermic men. Performing a pre-orchidectomy semen analysis is important to identify those with azoospermia or severe oligospermia in order to plan for cryopreservation or onco-TESE in young men who wish to conceive.
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Affiliation(s)
- Karl H Pang
- Academic Urology Unit, University of Sheffield, Sheffield, UK.,Section of Andrology, Pyrah Department of Urology, St James's Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nadir I Osman
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Asif Muneer
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,NIHR Biomedical Research Centre, UCLH, London, UK
| | - Hussain M Alnajjar
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.
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12
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Bandak M, Jensen A, Dehlendorff C, Lauritsen J, Kreiberg M, Wagner T, Rosenvilde J, Daugaard G. Paternity After Treatment for Testicular Germ Cell Cancer: A Danish Nationwide Population-Based Cohort Study. J Natl Cancer Inst 2021; 114:149-155. [PMID: 34180995 DOI: 10.1093/jnci/djab130] [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: 03/24/2021] [Revised: 05/26/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Testicular germ cell cancer (TC) incidence peaks in the reproductive age but knowledge on fertility after treatment is insufficient. The aim was to evaluate paternity after today's testicular cancer (TC) treatment. METHODS Clinical data were extracted from the Danish Testicular Cancer database and patients were divided into four groups: 1) Surveillance; 2) Bleomycin, etoposide, and cisplatin (BEP); 3) BEP + post-chemotherapy retroperitoneal surgery (BEP + surgery); and 4) Abdominal radiotherapy. For each patient, 10 men matched on date of birth were randomly sampled from the normal population. Paternity was defined as date of birth of first child after TC treatment with or without the use of assisted reproductive technology (ART) and was assessed by linkage to the Danish Medical Birth Register and the Danish in vitro fertilization (IVF)-register. RESULTS We included 4,846 unilateral TC patients and 48,456 men from the normal population. The 20 years predicted chance of obtaining fatherhood for a 30-year-old man was 39.7% in TC patients compared to 42.5 % in the normal population. The chance of obtaining fatherhood was statistically significantly decreased after BEP (hazard ratio [HR] = 0.87, 95% confidence interval [CI] = 0.78-0.97) and BEP + surgery (HR = 0.74 95% CI = 0.63-0.87), but not after radiotherapy (HR = 0.89, 95% CI = 0.75-1.06) or surveillance (HR = 0.95, 95% CI = 0.89-1.02). The risk of needing ART to obtain fatherhood was increased after all treatment modalities. CONCLUSION The chance of obtaining fatherhood after TC treatment was substantially higher than previously reported. Patients followed on a surveillance program had a similar chance of obtaining fatherhood as non-cancerous men.
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Affiliation(s)
- Mikkel Bandak
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Allan Jensen
- Virus, Lifestyle and Genes. Danish Cancer Society Research Center. Danish Cancer Society, Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics and Dataanalysis, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Jakob Lauritsen
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Kreiberg
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Wagner
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Josephine Rosenvilde
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gedske Daugaard
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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13
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Xavier R, de Carvalho RC, Fraietta R. Semen quality from patients affected by seminomatous and non-seminomatous testicular tumor. Int Braz J Urol 2021; 47:495-502. [PMID: 32459453 PMCID: PMC7993976 DOI: 10.1590/s1677-5538.ibju.2021.99.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/10/2020] [Indexed: 02/03/2023] Open
Abstract
Testicular cancer is considered a rare disease affecting approximately 1% to 2% of the male population. This neoplasm has a cure rate of over 95%; as a result, a major concern is the future of fertility of carriers from this disease. There are several histological subtypes of testicular tumors; however, the Testicular Germ Cell Tumors (TGCTs), comprising both seminoma and non-seminoma tumors, are considered the main subtypes of testicular neoplasms. TGCT are characterized by being a solid tumor that mostly affects young men aged between 15 and 40 years old. While TGCT subtypes may have an invasive potential, seminoma subtype does not affect other cells rather than germ cells, while non-seminomas have more invasive properties and can achieve somatic cells; thus, having a more aggressive nature. This research intends to review the literature regarding information about sperm parameters, correlating the data found in those studies to the subfertility and infertility of patients with TCGTs. Furthermore, it will also correlate the data to the non-seminoma and seminoma histological subtypes from pre- and post-cancer therapy. PubMed databases were used. Searched keywords included: seminoma AND non-seminoma; male infertility; germ cell tumor; chemotherapy AND radiotherapy. Only articles published in English were considered. Current studies demonstrate that both TGCT subtypes promote deleterious effects on semen quality resulting in decreased sperm concentration, declined sperm total motility and an increase in the morphology alterations. However, findings suggest that the non-seminoma subtype effects are more pronounced and deleterious. More studies will be necessary to clarify the behavior of seminoma and non-seminoma tumors implicating the reproductive health of male patients.
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Affiliation(s)
- Rosana Xavier
- Departamento de Cirurgia, Divisão de Urologia, Universidade Federal de São Paulo - UNIFESP São Paulo, SP, Brasil
| | - Renata Cristina de Carvalho
- Departamento de Cirurgia, Divisão de Urologia, Universidade Federal de São Paulo - UNIFESP São Paulo, SP, Brasil
| | - Renato Fraietta
- Departamento de Cirurgia, Divisão de Urologia, Universidade Federal de São Paulo - UNIFESP São Paulo, SP, Brasil
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14
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Scott C, Omar K, Alnajjar HM, Alifrangis C, Ahmed K, Muneer A. A patient-centric pathway for testicular cancer - A multicentre study investigating the uptake of semen cryopreservation and impact on treatment. Andrology 2021; 9:823-828. [PMID: 33527714 DOI: 10.1111/andr.12984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/15/2020] [Accepted: 01/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The option of semen cryopreservation following a diagnosis of testicular cancer shows a variable uptake with the option to cryopreserve before surgery often dependent on the preference of the treating clinician and the fertility laboratory resources available. OBJECTIVES To assess whether the introduction of a patient-centric pathway for managing suspected testicular cancer increases the uptake of semen cryopreservation and the impact of this on surgical waiting times. MATERIALS AND METHODS A multicentre retrospective analysis of patients treated as part of a patient-centric pathway was conducted for suspected testicular cancer at two specialist centres within a one-stop testicular clinic. Clinical information, including semen cryopreservation acceptance rate, time intervals to surgery and CT scan, TNM stage, histology and age, was recorded from an institutional database. RESULTS Eighty nine patients (median age: 34 years (range: 14-89)) underwent orchidectomy for suspected testicular cancer over a 15-month period after the introduction of a patient-centric testicular cancer pathway at two UK centres. The overall uptake of semen cryopreservation was 68.5% (n = 61) with all men under the age of 33 years accepting this option. A microdissection oncoTESE was performed in 9/61 (14.8%) patients who attempted cryopreservation but were found to be azoospermic. Pre-operative CT imaging was completed for 85.4% of patients, and the median time from initial outpatient consultation to orchidectomy was 9 days. DISCUSSION AND CONCLUSIONS A patient-centric pathway ensures that the uptake of semen cryopreservation remains high particularly for those men within the common age for paternity. It also identifies men who may benefit from microdissection oncoTESE for complex cases such as tumours in solitary testicles, bilateral tumours or an atrophic contralateral testicle as well as those diagnosed with de novo azoospermia. The additional time taken for semen cryopreservation to be performed did not significantly delay orchidectomy or influence the decisions for adjuvant treatment.
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Affiliation(s)
- Charles Scott
- Faculty of Life Sciences and Medicine, King's College London, London, UK.,University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Kawa Omar
- Department of Urology, King's College Hospital, London, UK
| | | | | | - Kamran Ahmed
- Department of Urology, King's College Hospital, London, UK.,MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.,King's Fertility, London, UK
| | - Asif Muneer
- Institute of Andrology, University College London Hospital, London, UK.,NIHR Biomedical Research Centre, University College London Hospital, London, UK.,Department of Surgery and Interventional Science, University College London, London, UK
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15
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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: 196] [Impact Index Per Article: 39.2] [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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16
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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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17
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Weibring K, Nord C, Ståhl O, Eberhard J, Sandberg K, Johansson H, Arver S, Giwercman A, Cohn-Cedermark G. Sperm count in Swedish clinical stage I testicular cancer patients following adjuvant treatment. Ann Oncol 2019; 30:604-611. [PMID: 30798330 DOI: 10.1093/annonc/mdz017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Little is known regarding sperm production following adjuvant treatment in testicular cancer (TC) clinical stage I (CS I) patients. PATIENTS AND METHODS A total of 182 TC patients aged 18-50 years were prospectively included during 2001-2006 at any given time within 5 years of orchiectomy. Semen samples were delivered postorchiectomy but before further treatment, 6, 12, 24, 36 and 60 months (T0-T60) after completed therapy. Total sperm number (TSN) and sperm concentration (SC) were used as measurements of testicular function. Four groups according to treatment modality were identified; Radiotherapy; To a total dose of 25.2 Gy to the infradiaphragmal paraaortic and ipsilateral iliac lymph nodes (RT, N = 70), one cycle of adjuvant BEP (bleomycin, etoposide, cisplatin, 5 day regimen) (BEP, N = 62), one cycle of adjuvant carboplatin AUC 7 (Carbo, N = 22), and patients managed by surveillance (SURV, N = 28). RESULTS In the cross-sectional analysis, a significant but transient drop in mean TSN and mean SC (T0-T60) was seen at T6 after radiotherapy. Apart from a significant increase in mean SC at T12 compared with baseline, no significant differences were observed in the other treatment groups. In 119 patients delivering 3 or more samples, values in TSN and SC were rather stable over time. Azoospermic patients (N = 11) were observed in most treatment groups except for in the BEP group. During follow-up, one azoospermic patient belonging to the Carbo group became normospermic. CONCLUSIONS No clinically significant long-term effect on TSN or SC associated with adjuvant treatment in TC CSI patients was found. However, as patients may have low sperm counts before orchiectomy as well as after adjuvant treatment, we offer sperm banking before orchiectomy as assisted reproductive measures may be necessary regardless of treatment given.
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Affiliation(s)
- K Weibring
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm.
| | - C Nord
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund
| | - J Eberhard
- Department of Oncology, Skane University Hospital, Lund
| | - K Sandberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
| | - H Johansson
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
| | - S Arver
- Department of Medicine/Huddinge, Karolinska Institute, Stockholm; Centre for Andrology and Sexual Medicine, Karolinska University Hospital, Stockholm
| | - A Giwercman
- Department of Translational Medicine, Lund University, Malmo, Sweden
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
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18
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Andrade MBR, Bertolla RP, Intasqui P, Antoniassi MP, Tibaldi DS, Belardin LB, Spaine DM. Effect of orchiectomy on sperm functional aspects and semen oxidative stress in men with testicular tumours. Andrologia 2018; 51:e13205. [DOI: 10.1111/and.13205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/30/2018] [Accepted: 10/18/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Maria B. R. Andrade
- Division of Urology, Department of Surgery, Human Reproduction Section; Sao Paulo Federal University - Sao Paulo Hospital; Sao Paulo Brazil
| | - Ricardo P. Bertolla
- Division of Urology, Department of Surgery, Human Reproduction Section; Sao Paulo Federal University - Sao Paulo Hospital; Sao Paulo Brazil
| | - Paula Intasqui
- Division of Urology, Department of Surgery, Human Reproduction Section; Sao Paulo Federal University - Sao Paulo Hospital; Sao Paulo Brazil
| | - Mariana P. Antoniassi
- Division of Urology, Department of Surgery, Human Reproduction Section; Sao Paulo Federal University - Sao Paulo Hospital; Sao Paulo Brazil
| | - Danielle S. Tibaldi
- Division of Urology, Department of Surgery, Human Reproduction Section; Sao Paulo Federal University - Sao Paulo Hospital; Sao Paulo Brazil
| | - Larissa B. Belardin
- Division of Urology, Department of Surgery, Human Reproduction Section; Sao Paulo Federal University - Sao Paulo Hospital; Sao Paulo Brazil
| | - Deborah M. Spaine
- Division of Urology, Department of Surgery, Human Reproduction Section; Sao Paulo Federal University - Sao Paulo Hospital; Sao Paulo Brazil
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19
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20
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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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21
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Kurobe M, Kawai K, Suetomi T, Iwamoto T, Waku N, Kawahara T, Kojima T, Joraku A, Miyazaki J, Nishiyama H. High prevalence of hypogonadism determined by serum free testosterone level in Japanese testicular cancer survivors. Int J Urol 2018; 25:457-462. [PMID: 29478250 DOI: 10.1111/iju.13537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 01/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Hypogonadism is a major complication in testicular cancer survivors, but its prevalence varies among studies. In Japan, free testosterone has been used for diagnosis of late-onset hypogonadism syndrome. In the present study, we evaluated the hormone level of testicular cancer survivors and its impact on their quality of life. METHODS Overall, 50 testicular cancer survivors treated from 1990 to 2013 were enrolled. The median age was 44 years. The serum levels of free testosterone, total testosterone and luteinizing hormone were measured. All patients completed the Aging Males' Symptom scale and International Index of Erectile Function-15. The hormone levels of 337 healthy volunteers were used as the control. RESULTS A total of 32 (64%) patients showed free testosterone levels <8.5 pg/mL. In contrast, just 26% of 50 patients showed total testosterone levels <3.5 ng/mL. Testicular cancer survivors had significantly lower free testosterone and higher luteinizing hormone compared with healthy controls. In contrast, there was no difference in total testosterone between patients and controls. The prevalence of late-onset hypogonadism symptoms of any grade (Aging Males' Symptom total score ≥27) was 60%. Overall, 64% were defined as having moderate erectile dysfunction (International Index of Erectile Function-Erectile Function domain score <17). However, Aging Males' Symptom, International Index of Erectile Function-15 and Erectile Function domain scores did not differ by free testosterone or total testosterone level. CONCLUSIONS This is the first report on the prevalence of hypogonadism determined by free testosterone level in Japanese testicular cancer survivors. Because Aging Males' Symptom and International Index of Erectile Function-15 scores do not necessarily reflect the hormone level, measuring free testosterone is also important in the follow up of these patients.
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Affiliation(s)
- Masahiro Kurobe
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Urology, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Koji Kawai
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takahiro Suetomi
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Teruaki Iwamoto
- Division of Male Infertility Center for Human Reproduction, Sanno Hospital, Tokyo, Japan
| | - Natsui Waku
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takashi Kawahara
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takahiro Kojima
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Joraku
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Jun Miyazaki
- Department of Urology, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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22
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Physical long-term side-effects in young adult cancer survivors: germ cell tumors model. Curr Opin Oncol 2017; 29:229-234. [PMID: 28463858 DOI: 10.1097/cco.0000000000000375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW After the important advances in the treatment of germ cell tumors (GCTs) leading to high cure rates, physical long-term side-effects represent an important cause of death in these young adult survivors. Highlighting these physical long-term side-effects, their monitoring and their prevention modalities is necessary for a better management of these cancer survivors. RECENT FINDINGS Impaired fertility, increased risk of developing a second cancer, cardiac, pulmonary, renal and neural toxicity, hearing and vision impairment are the major physical side-effects in young adult cancer survivors. Long-term cardiac toxicity, next to second malignancies, represents life-threatening conditions in testicular cancer survivors. The long-term nephrotoxity in testicular GCTs survivors is most frequently associated to the treatment either in those treated with cisplatin-based chemotherapy, mainly Bleomycine, Etoposide, Cisplatin, or those receiving infradiaphragmatic radiation therapy, whereas pulmonary toxicity is mainly attributed to bleomycin related toxicities. SUMMARY There are no clear and comprehensive data concerning the monitoring and prevention of long-term side-effects in testicular cancer survivors. Physical activity and interventions in modifiable cardiovascular risk factors and lifestyles may reduce the incidence of long-term side-effects in these cancer survivors.
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23
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Bandak M, Jørgensen N, Juul A, Lauritsen J, Kier MGG, Mortensen MS, Oturai PS, Mortensen J, Hojman P, Helge JW, Daugaard G. Reproductive hormones and metabolic syndrome in 24 testicular cancer survivors and their biological brothers. Andrology 2017; 5:718-724. [PMID: 28598554 DOI: 10.1111/andr.12355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/30/2017] [Accepted: 02/07/2017] [Indexed: 01/22/2023]
Abstract
Testicular cancer survivors have impaired gonadal function and increased risk of metabolic syndrome when compared to healthy controls. However, because of the fetal etiology of testicular cancer, familial unrelated healthy men might not be an optimal control group. The objective of this study was to clarify if testicular cancer survivors have impaired gonadal function and increased risk of metabolic syndrome when compared to their biological brothers. A cross-sectional study of testicular cancer survivors (ClinicalTrials.gov number, NCT02240966) was conducted between 2014 and 2016. Of 158 testicular cancer survivors included, 24 had a biological brother who accepted to participate in the study. Serum levels of reproductive hormones and prevalence of metabolic syndrome according to International Diabetes Federation Criteria and National Cholesterol Education Program (Adult Treatment Panel III) criteria comprised the main outcome measures of the study. Median age was similar in testicular cancer survivors and their biological brothers [44 years (IQR 39-50) vs. 46 (40-53) years respectively (p = 0.1)]. In testicular cancer survivors, follow-up since treatment was 12 years (7-19). Serum levels of luteinizing hormone and follicle-stimulating hormone were elevated (p ≤ 0.001), while total testosterone, free testosterone, inhibin B and anti-Müllerian hormone were lower (p ≤ 0.001) in testicular cancer survivors than in their biological brothers. The prevalence of metabolic syndrome was similar and apart from HDL-cholesterol, which was lower in testicular cancer survivors (p = 0.01); there were no differences in the individual components of the metabolic syndrome between testicular cancer survivors and their brothers. In conclusion, gonadal function was impaired in testicular cancer survivors, while we did not detect any difference in the prevalence of metabolic syndrome between testicular cancer survivors and their biological brothers.
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Affiliation(s)
- M Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - N Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Copenhagen, Denmark
| | - A Juul
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), University of Copenhagen, Copenhagen, Denmark
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - M G G Kier
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Unit of Survivorship, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - M S Mortensen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - P S Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J Mortensen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - P Hojman
- Centre of Physical Activity Research, Centre of Inflammation and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J W Helge
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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24
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Préservation de la fertilité chez les adolescents et jeunes adultes traités pour cancer. Bull Cancer 2016; 103:1019-1034. [DOI: 10.1016/j.bulcan.2016.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/08/2016] [Accepted: 10/08/2016] [Indexed: 01/15/2023]
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25
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Rombaut C, Faes K, Goossens E. The Effect of a Unilateral Orchiectomy before Gonadotoxic Treatment on the Contralateral Testis in Adult and Prepubertal Rats. PLoS One 2016; 11:e0164922. [PMID: 27768736 PMCID: PMC5074494 DOI: 10.1371/journal.pone.0164922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/03/2016] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Previous studies have shown that the removal of one testis leads to a compensatory mechanism in the contralateral one, but this was species and age dependent. The aim of this study was to check whether this compensation would still occur after the combination of a unilateral orchiectomy and gonadotoxic treatment, since this resembles the clinical situation of patients who have to undergo highly toxic cancer treatment and therefore choose to cryopreserve a testicular biopsy for fertility restoration purposes. MATERIALS & METHODS Sprague Dawley rats underwent either unilateral orchiectomy, gonadotoxic busulfan treatment, the combination of both or served as fertile control. A comparison of the compensatory effects was made between adult and prepubertal treated rats. Mating experiments were performed, testosterone levels were followed-up, testicular weight was recorded and histology was analysed. RESULTS Adult treated rats were able to restore fertility spontaneously in all treatment groups. On the other hand, 30% of the rats that underwent a unilateral orchiectomy and gonadotoxic treatment at prepubertal age showed hampered spermatogenesis, low testosterone levels, decreased testicular weights and were not able to reproduce. CONCLUSION This study emphasizes the need of fertility preservation strategies in prepubertal patients before gonadotoxic interventions.
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Affiliation(s)
- Charlotte Rombaut
- Biology of the Testis, Research Laboratory for Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- * E-mail:
| | - Katrien Faes
- Biology of the Testis, Research Laboratory for Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ellen Goossens
- Biology of the Testis, Research Laboratory for Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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26
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Polland A, Berookhim BM. Fertility concerns in men with genitourinary malignancies: Treatment dilemmas, fertility options, and medicolegal considerations. Urol Oncol 2016; 34:399-406. [DOI: 10.1016/j.urolonc.2016.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 04/10/2016] [Accepted: 05/04/2016] [Indexed: 12/11/2022]
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27
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Bandak M, Jørgensen N, Juul A, Vogelius IR, Lauritsen J, Kier MG, Mortensen MS, Glovinski P, Daugaard G. Testosterone deficiency in testicular cancer survivors - a systematic review and meta-analysis. Andrology 2016; 4:382-8. [DOI: 10.1111/andr.12177] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/21/2015] [Accepted: 02/01/2016] [Indexed: 11/27/2022]
Affiliation(s)
- M. Bandak
- Department of Oncology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - N. Jørgensen
- Department of Growth and Reproduction; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - A. Juul
- Department of Growth and Reproduction; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - I. R. Vogelius
- Department of Oncology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - J. Lauritsen
- Department of Oncology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - M. G. Kier
- Department of Oncology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
- Department of Survivorship; Danish Cancer Society; Copenhagen Denmark
| | - M. S. Mortensen
- Department of Oncology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - P. Glovinski
- Department of Breast Surgery and Reconstructive Surgery; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - G. Daugaard
- Department of Oncology; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
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28
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Auger J, Jouannet P, Eustache F. Another look at human sperm morphology. Hum Reprod 2015; 31:10-23. [DOI: 10.1093/humrep/dev251] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/15/2015] [Indexed: 01/11/2023] Open
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29
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Pan BS, Wang YK, Lai MS, Mu YF, Huang BM. Cordycepin induced MA-10 mouse Leydig tumor cell apoptosis by regulating p38 MAPKs and PI3K/AKT signaling pathways. Sci Rep 2015; 5:13372. [PMID: 26303320 PMCID: PMC4548195 DOI: 10.1038/srep13372] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 07/24/2015] [Indexed: 01/07/2023] Open
Abstract
The p38 MAPKs play important roles in the regulation of balance between cell survival and cell death on the development of various cancers. However, the roles of p38 MAPKs regulating apoptotic effects on Leydig tumor cells remain unclear. In the present study, we showed that cordycepin (3′-deoxyadenosine) selectively induced apoptosis in MA-10 mouse Leydig tumor cells through regulating the p38 MAPK and PI3K/AKT signaling pathways. Cordycepin reduced viability in MA-10, TM4, and NT2/D1 cells, but not cause cell death of primary mouse Leydig cells on moderate concentration. Cordycepin increased reactive oxygen species (ROS) levels, which is associated with the induction of apoptosis as characterized by positive Annexin V binding, activation of caspase-3, and cleavage of PARP. Inhibition of p38 MAPKs activity by SB203580 significantly prevented cordycepin-induced apoptosis in MA-10 cells. Co-treatment with wortmannin or the autophagy inhibitor 3-methyladenine (3-MA) elevated levels of apoptosis in cordycepin-treated MA-10 cells. Moreover, cordycepin activated p53, p21 and TGFß; and downregulated CDK2. The antitumour activity of cordycepin-treated MA-10 cells was significantly distinct in severe combined immunodeficiency (SCID) mice in vivo. These results suggested that cordycein is a highly selective treatment to induce MA-10 cells apoptosis via p38 MAPKs signaling.
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Affiliation(s)
- Bo-Syong Pan
- Institute of Basic Medical Sciences, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China.,Department of Cell Biology and Anatomy, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China
| | - Yang-Kao Wang
- Institute of Basic Medical Sciences, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China.,Department of Cell Biology and Anatomy, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China
| | - Meng-Shao Lai
- Institute of Basic Medical Sciences, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China.,Department of Cell Biology and Anatomy, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China
| | - Yi-Fen Mu
- Department of Cell Biology and Anatomy, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China
| | - Bu-Miin Huang
- Institute of Basic Medical Sciences, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China.,Department of Cell Biology and Anatomy, College of Medicine, National Chen Kung University, Tainan, Taiwan, Republic of China
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30
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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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31
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Clinical guidelines for sperm cryopreservation in cancer patients. Fertil Steril 2013; 100:1203-9. [DOI: 10.1016/j.fertnstert.2013.08.054] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 08/18/2013] [Accepted: 08/30/2013] [Indexed: 11/18/2022]
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33
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Bujan L, Walschaerts M, Moinard N, Hennebicq S, Saias J, Brugnon F, Auger J, Berthaut I, Szerman E, Daudin M, Rives N. Impact of chemotherapy and radiotherapy for testicular germ cell tumors on spermatogenesis and sperm DNA: a multicenter prospective study from the CECOS network. Fertil Steril 2013; 100:673-80. [PMID: 23755953 DOI: 10.1016/j.fertnstert.2013.05.018] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/03/2013] [Accepted: 05/03/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the consequences of adjuvant testicular germ cell tumor treatment (TGCT) on sperm characteristics and sperm DNA, and to evaluate the predictors of sperm recovery. DESIGN Multicenter prospective longitudinal study of patients analyzed before treatment and after 3, 6, 12, and 24 months. SETTING University hospitals. PATIENT(S) One hundred twenty-nine volunteer TGCT patients and a control group of 257 fertile men. INTERVENTION(S) Routine semen analyses, sperm DNA, and chromatin assessments. MAIN OUTCOME MEASURE(S) Comparisons of mean sperm characteristics before and after treatment, with sperm recovery analyzed by the Kaplan-Meier method. RESULT(S) The quantitative and qualitative sperm characteristics decreased after treatment, with lowest values at 3 and 6 months and with variations according to treatment type. The mean total sperm count recovered to pretreatment values at 12 months after treatment after two or fewer bleomycin, etoposide, and cisplatin (BEP) cycles, but not after radiotherapy or more than two BEP cycles. Only the treatment modalities and pretreatment sperm production were related to recovery of the World Health Organization reference sperm values. An increased proportion of patients had elevated high sperm DNA stainability at 6 months after radiotherapy. CONCLUSION(S) Adjuvant treatments for testicular germ cell tumor have drastic effects on spermatogenesis and sperm chromatin quality. These new data on both the recovery period according to treatment modalities and the post-treatment chromatin status of sperm are useful tools for counseling patients wishing to conceive.
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Affiliation(s)
- Louis Bujan
- Fédération Française des Centre d'Étude et de Conservation des Œufs et du Sperme Humains (CECOS), Paris, France.
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34
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Stoehr B, Schachtner L, Pichler R, Holzner B, Giesinger J, Oberguggenberger A, Leonhartsberger N, Horninger W, Steiner H. Influence of achieved paternity on quality of life in testicular cancer survivors. BJU Int 2012; 111:E207-12. [DOI: 10.1111/j.1464-410x.2012.11579.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Irkilata HC, Kibar Y, Basal S, Kurt B, Gunal A, Alp BF, Oral E, Musabak U, Tahmaz L, Dayanc M. The impact of simple orchiectomy on semen quality and endocrine parameters in postpubertal cryptorchid men. Int Urol Nephrol 2012; 44:1617-22. [PMID: 22865396 DOI: 10.1007/s11255-012-0256-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/13/2012] [Indexed: 11/27/2022]
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36
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Tomlinson MJ, Kohut TL, Hopkisson JF, Lemberger RJ. Routine sperm banking for testicular cancer patients should be performed both before and after orchidectomy. JOURNAL OF CLINICAL UROLOGY 2012. [DOI: 10.1016/j.bjmsu.2012.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Despite some groups recommending that sperm banking for testicular cancer patients prior to orchidectomy results in improved overall semen quality, it remains common practice for this to occur post operatively, prior to any chemotherapy. Having seen anecdotal evidence of patients being rendered azoospermic and thus sterile by unilateral orchidectomy, we investigated further. Methods: Forty men listed for orchidectomy banked a single sample before surgery and were then given the opportunity to bank further samples post operatively. Results: Post orchidectomy, overall sperm concentration ( p = 0.01) and motility ( p < 0.05) were lower compared to before surgery and two men had azoospermia. However, the overall picture was misleading as in 13 individuals their sperm output was increased ( n = 13) after surgery. Both cases of post operative azoospermia were amongst the patients with seminoma although at least 50% of patients with teratoma had severe oligozoospermia post surgery. Conclusions: Despite the relatively high frequency of normal sperm counts amongst seminoma patients, there was no significant difference in total sperm output or sperm quality between these men and those with teratoma or mixed cell tumours. As overall sperm quality was lower after surgery and some patients had totally compromised fertility, our centre has changed its policy to encouraging sperm banking prior to surgery. However, we maintain that generalisation of this population is unwise and patients should also attend after surgery to optimise the quality of their samples in the sperm bank.
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Affiliation(s)
- MJ Tomlinson
- Fertility Unit, Nottingham University Hospital, Nottingham, UK
| | - TL Kohut
- Fertility Unit, Nottingham University Hospital, Nottingham, UK
| | - JF Hopkisson
- Fertility Unit, Nottingham University Hospital, Nottingham, UK
| | - RJ Lemberger
- Department of Urology, Nottingham University Hospital, Nottingham, UK
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37
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Abstract
The current concepts, recommendations, and principles of sperm banking as it pertains to the comprehensive care of young men of reproductive age with cancer are reviewed. Obstacles to sperm banking are addressed as well as future directions for fertility-preserving technologies. All cancer therapies-chemotherapy, radiation, and surgery-are potential threats to a man's reproductive potential. In addition, cancer itself can impair spermatogenesis. Thus, sperm cryopreservation prior to initiating life-saving cancer treatment offers men and their families the best chance to father biologically related children and should be offered to all men with cancer before treatment. Better patient and provider education, as well as deliberate, coordinated strategies at comprehensive cancer care centers are necessary to make fertility preservation for male cancer patients a priority during pretreatment planning.
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Affiliation(s)
- Daniel H Williams
- Department of Urology, University of Wisconsin-Madison,600 Highland Avenue,Madison, WI 53792, USA
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38
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The pituitary-Leydig cell axis before and after orchiectomy in patients with stage I testicular cancer. Eur J Cancer 2011; 47:2585-91. [DOI: 10.1016/j.ejca.2011.05.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/18/2011] [Accepted: 05/18/2011] [Indexed: 11/23/2022]
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Selice R, Ferlin A, Garolla A, Caretta N, Foresta C. Effects of endogenous FSH on normal human spermatogenesis in adults. ACTA ACUST UNITED AC 2011; 34:e511-7. [PMID: 21790654 DOI: 10.1111/j.1365-2605.2010.01134.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Unilateral orchiectomy (UO) in adult bonnet monkeys and boars elicits a compensatory increase in size and sperm production of the remaining testis. The objective of this study was to investigate whether a similar effect is evident also in humans. We prospectively studied 50 patients from October 2003 to December 2005 who underwent UO for seminomatous tumour, with sperm concentration >20 × 10(6) /mL or total sperm count >40 × 10(6) at diagnosis and without elevation of serum tumour markers. Patients were followed-up with surveillance and they were studied at the time of diagnosis of testicular cancer (T(-1) ), 1 month after unilateral orchiectomy (T(0) ) and yearly for 3 years (T(1) , T(2) , T(3) ) with semen analysis, measurement of plasma levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), inhibin B, total testosterone, and oestradiol and ultrasonographic scanning of the remaining testis. A decline in circulating inhibin B and an increase in FSH levels were evident 1 month after UO. The elevation of FSH was maintained up to 3 years and was associated with a significant increase in testicular volume of 19 and 30%, 2 and 3 years after UO respectively. Although patients had normozoospermia at the time of diagnosis of testicular cancer, they showed a statistically significant increase in total sperm count at T(2) and T(3) with respect to T(-1) and T(0.) In conclusion, we showed that in humans, the testes are not normally operating at their maximal potential in terms of spermatogenesis. Therefore, in physiological situations, FSH secretion is insufficient to stimulate spermatogenesis to its ceiling. A sustained endogenous increase in FSH secretion might drive human testes towards their maximal function.
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Affiliation(s)
- R Selice
- Section of Clinical Pathology, Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, University of Padova, Padova, Italy
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Evaluation and Preservation of Fertility in Patients with Testicular Cancer. J Adolesc Young Adult Oncol 2011; 1:25-9. [DOI: 10.1089/jayao.2011.0004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bonetti TCS, Pasqualotto FF, Queiroz P, Iaconelli A, Borges E. Sperm banking for male cancer patients: social and semen profiles. Int Braz J Urol 2010; 35:190-7; discussion 197-8. [PMID: 19409123 DOI: 10.1590/s1677-55382009000200009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Report the characteristics of cryopreserved semen from a cohort of male cancer patients, attitudes towards cryopreservation and outcomes of semen samples based on a 12-year cryopreservation program. MATERIAL AND METHODS Data from 98 male cancer patients whose sperm samples were banked were evaluated. Demographic parameters, semen characteristics, destination of sperm banked samples and questionnaires answered by the patients regarding cryopreservation time were evaluated. RESULTS The cancer diagnoses were testicle (56.1%), prostate (15.3%), Hodgkin's lymphomas (9.2%), non-Hodgkin's lymphomas (7.1%), leukemia (3.1%) and other malignancies (9.2%). The patients with testicular cancer presented lower sperm concentration (p < 0.001); however, there were no differences with the percentage of normozoospermic patients among cancer type groups (p = 0.185). A shorter time between cancer diagnosis and sperm banking was observed for testicular and prostate cancer patients (p < 0.001). Most of the patients (89.5%) favored sperm banking as a fertility preservation method. CONCLUSIONS Although less than 20% of banked sperm samples were disposed of, the majority of patients related sperm banking with safe for fertility preservation. Our results show that all male cancer patients of reproductive age facing cancer treatment could be offered sperm banking.
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Sartorius GA, Handelsman DJ. Testicular Dysfunction in Systemic Diseases. Andrology 2010. [DOI: 10.1007/978-3-540-78355-8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sarraj MA, Escalona RM, Umbers A, Chua HK, Small C, Griswold M, Loveland K, Findlay JK, Stenvers KL. Fetal testis dysgenesis and compromised Leydig cell function in Tgfbr3 (beta glycan) knockout mice. Biol Reprod 2009; 82:153-62. [PMID: 19696014 DOI: 10.1095/biolreprod.109.078766] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Betaglycan (Tgfbr3) is a coreceptor for transforming growth factor-beta (TGFB) superfamily ligands. In the current study, a defect in seminiferous cord formation was detected in 12.5-13.5 days postcoitum (dpc) beta glycan null murine testis. Immunohistochemistry with antibodies against cell-specific markers revealed defects in somatic cell populations. To confirm these data, quantitative real-time PCR was performed to determine changes in the expression levels of genes involved in fetal testis cell differentiation and function. The expression levels of the Leydig cell markers Insl3, Cyp17a1, Cyp11a1, Star, and Hsd3b1 were reduced in knockout testis compared to wild-type testis, beginning at 12.5 dpc. Whole mount in situ hybridization confirmed that Cyp11a1 expression was reduced in the null testis, but its distribution pattern was unchanged. Apoptosis was not affected by the loss of beta glycan, but proliferation within the interstitium was reduced at 14.5 dpc. However, morphometric analysis showed no changes in Leydig cell counts between the wild-type and the knockout testes at 14.5 dpc, indicating that fetal Leydig function, rather than number, was affected by the loss of beta glycan. The expression levels of Sertoli cell markers Dhh, Sox9, and Amh were also reduced in the knockout testis at 14.5 dpc. However, the expression of fetal germ cell markers Pou5f1 and DDX4 were not changed across the genotypes at any age examined. Our data show that the presence of beta glycan is required for normal cord formation, normal fetal Leydig cell development, and the establishment of fetal testis endocrine function, thus implicating TGFB superfamily members as regulators of early fetal testis structure and function.
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Affiliation(s)
- Mai A Sarraj
- Prince Henry's Institute of Medical Research, Clayton, Victoria, Australia.
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Sabanegh ES, Ragheb AM. Male Fertility After Cancer. Urology 2009; 73:225-31. [DOI: 10.1016/j.urology.2008.08.474] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 08/04/2008] [Accepted: 08/07/2008] [Indexed: 11/25/2022]
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Testicular sperm extraction in a single cancerous testicle in patients with azoospermia: a case report. Fertil Steril 2008; 90:443.e1-4. [DOI: 10.1016/j.fertnstert.2007.07.1308] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 06/12/2007] [Accepted: 07/10/2007] [Indexed: 11/18/2022]
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Eberhard J, Ståhl O, Cwikiel M, Cavallin-Ståhl E, Giwercman Y, Salmonson EC, Giwercman A. Risk factors for post-treatment hypogonadism in testicular cancer patients. Eur J Endocrinol 2008; 158:561-70. [PMID: 18362304 DOI: 10.1530/eje-07-0684] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Testicular germ-cell cancer (TGCC) patients are at risk of developing hypogonadism but no risk factors have yet been defined. METHODS Blood was collected from 143 TGCC patients (after orchidectomy, prior to further therapy (T0) and 6, 12, 24, 36 and 60 months (T6, T12, T24, T36 and T60) after therapy). Biological hypogonadism (BH) was defined as: serum testosterone below 10 nmol/l and/or LH >10 IU/l; odds ratios (ORs) for BH with BH at T0, age, stage of disease, testicular characteristics, and androgen receptor polymorphism as predictors were calculated as well as the OR for developing BH post-treatment (one to two cycles of adjuvant chemotherapy (ACT) versus three to four cycles of higher dose chemotherapy (HCT) versus adjuvant radiotherapy (RT)). RESULTS HCT increased the OR for BH at T6 (OR 22, 95% confidence interval (CI) 4.4-118) and T12 (OR 5.8, 95% CI 1.5-22). RT increased the OR at T6 (OR 10, 95% CI 2.1-47) and at T12 (OR 3.9, 95% CI 1.1-14). Microlithiasis predicted BH at T0 (OR 11, 95% CI 1.2-112), T12 (OR 3.9, 95% CI 1.1-13), T24 (OR 3.0, 95% CI 1.0-8.8), T36 (OR 5.4, 95% CI 1.7-17) and T60 (OR 4.4, 95% CI 1.2-16). BH at T0 was a risk for BH at T6 (OR 53, 95% CI 19-145), T12 (OR 125, 95% CI 37-430), T24 (OR 88, 95% CI 26-300) and T36 (OR 121, 95% CI 32-460). CONCLUSIONS It is clinically relevant that BH at T0 and testicular microlithiasis were predictive factors for post-treatment BH. HCT and RT gave temporary BH.
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Affiliation(s)
- Jakob Eberhard
- Department of Oncology, Lund University Hospital, Lund University, SE 22185 Lund, Sweden.
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Abstract
Gonadal dysfunction and fertility problems are adverse effects of cancer treatment or may be associated with specific malignancies. This review focuses on these problems in the young cancer survivors, where methods of protecting or restoring endocrine function and fertility need to be considered. In females, treatment adverse effects can result in infertility, but premature ovarian failure (POF) is probably relevant for more female cancer survivors, affecting also those who do not wish post-treatment parenthood. POF affects present and future health, especially through oestrogen deficiency symptoms and an increased risk of developing osteoporosis. A lower risk of developing POF has been considered in young females than in older due to a larger pool of oocytes. However, a recent long-term follow-up study reported a prevalence of POF in young females with Hodgkin's lymphoma of 37% showing that young age at time of treatment only delays the development of POF. In male gonads, germ cells are much more sensitive to irradiation and chemotherapy than Leydig cells. Thus, infertility is a more common adverse effect than hypogonadism. Some malignancies are particular relevant. Persistent azoospermia was formerly common after treatment for Hodgkin's lymphoma, but currently, most patients recover spermatogenesis. Modern treatment of childhood acute lymphoblastic leukemia is also unlikely to cause infertility. Norwegian testicular cancer survivors diagnosed in 1980-1994 who attempted conception had an overall 15-year actuarial post-treatment paternity rate of 71% (range 48-92% depending on the treatment). However, the rate was significantly higher among men diagnosed in1989-1994 (over 80%) than in 1980-1988 (about 63%). Patients at risk for hypogonadism and infertility should be defined prior to treatment, and available methods for gonadal preservation should maximally be utilised. During follow-up, oncologists should routinely address these issues.
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Affiliation(s)
- Marianne Brydøy
- Department of Oncology, Haukeland University Hospital, Bergen, Norway.
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Fosså SD, Travis LB, Dahl AA. Medical and Psychosocial Issues in Testicular Cancer Survivors. Oncology 2007. [DOI: 10.1007/0-387-31056-8_104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW Testicular cancer and infertility affect a similar age group of patients and have common biologic, epidemiologic, and environmental backgrounds. In this review, we provide current literature on links between infertility and testicular cancer, and new developments in the management of testicular cancer aimed at improving quality of life in men with testicular cancer. RECENT FINDINGS In-utero environmental exposure to endocrine disruptors modulates the genetically determined fate of primitive gonad and results in testicular dysgenesis syndrome, which may result in infertility and testicular cancer. Excellent response of testicular cancer to radiation and chemotherapy results in over 90% of survival and quality of life--fertility and sexual function--is of significant concern to patients and clinicians. The testicular-sparing management of testicular masses emerges as a sound alternative to radical orchiectomy and allows for preservation of spermatogenesis and hormonal function, and at the same time achieving similar survival rates. Secondary malignancies, pulmonary, and cardiovascular complications are recognized as late complications of treatment for testicular cancer. SUMMARY Better understanding of common mechanisms involved in infertility and testicular cancer, and scientifically driven evidence-based treatment options should improve quality of life in young men faced with this potentially life-threatening disease.
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Affiliation(s)
- Darius A Paduch
- Department of Urology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA.
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Atwood CS, Bowen RL. Metabolic clues regarding the enhanced performance of elite endurance athletes from orchiectomy-induced hormonal changes. Med Hypotheses 2007; 68:735-49. [DOI: 10.1016/j.mehy.2006.08.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Accepted: 08/16/2006] [Indexed: 02/02/2023]
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