1
|
Appaneravanda LC, Gerstl B, Nagaraju A, Kumar A, Sanna Balamukund I, Gunasheela D. A Descriptive Study Exploring Semen Quality Among Indian Cancer Patients. J Adolesc Young Adult Oncol 2021; 10:690-696. [PMID: 33835860 DOI: 10.1089/jayao.2021.0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To descriptively explore semen quality among Indian men with various types of malignancies. We evaluated semen parameters of male patients referred to our hospital before commencing their cancer treatment. Methods: Four hundred sixty-one male patients who were within the age range of 15-50 years were recruited with diagnosed malignancies. Pre-treatment semen analyses were performed on these patients to collect data on the volume, sperm concentration, motility, and normal forms (morphology). These semen parameters were compared between cancer groups (testicular cancer, hematological cancer, and other cancers). Further comparisons were also drawn to World Health Organization (WHO) semen parameter levels (2010, fifth edition) for normal outcomes. Results: There were no notable variations observed in semen volume (mL) and progressive motility (%) between cancer groups. These parameters were within the WHO normal semen criteria. Differences in normal forms (%) between cancer groups were not observed either; however, they were marginally lower compared with the WHO criteria. Sperm concentration was evidently lower in testicular cancer 34 × 106/mL (IQR: 10.1-60 × 106/mL) compared with hematological cancers 66 × 106/mL (IQR: 23-84.21 × 106/mL) and other cancers (IQR: 27-86.3 × 106/mL). Testicular cancer patients also presented with the largest semen disorder diagnosis (Asthenozoospermia, Oligoasthenozoospermia, Oligozoospermia, and Azoospermia) compared with two other groups. Conclusion: Males with testicular cancer have shown to have lower semen quality between cancer groups and compared with WHO criteria, increasing their likelihood of them being infertile. This study further allows us to understand these outcomes, particularly in the Indian subpopulation, propagating changes in guidelines in oncofertility and medical counseling. Clinical Trials Registry-India number: CTRI/2020/09/027720.
Collapse
Affiliation(s)
| | - Brigitte Gerstl
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bangalore, India.,Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia
| | - Ashwini Nagaraju
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bangalore, India
| | - Arun Kumar
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bangalore, India.,Department of Biostatistics, Gunasheela Surgical and Maternity Hospital, Bangalore, India
| | - Indrani Sanna Balamukund
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bangalore, India.,Department of Andrology, Gunasheela Surgical and Maternity Hospital, Bangalore, India
| | - Devika Gunasheela
- Department of Reproductive Medicine, Gunasheela Surgical and Maternity Hospital, Bangalore, India
| |
Collapse
|
2
|
Gerstl B, Bertoldo MJ, Sullivan E, Volckmar X, Kerr A, Wand H, Ives A, Albalawi O, Anazodo A. Fatherhood Following Treatment for Testicular Cancer: A Systematic Review and Meta-Analyses. J Adolesc Young Adult Oncol 2020; 9:341-353. [DOI: 10.1089/jayao.2019.0164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brigitte Gerstl
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
- Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia
| | - Michael J. Bertoldo
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Elizabeth Sullivan
- Faculty Health and Medicine, The University of Newcastle, Newcastle, Australia
| | - Xanthie Volckmar
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Aidan Kerr
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Handan Wand
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Angela Ives
- Cancer and Palliative Care Research and Evaluation Unit, University of Western Australia, Crawley, Australia
| | - Olayan Albalawi
- Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Statistics, Science College, Tabuk University, Tabuk, Saudi Arabia
| | - Antoinette Anazodo
- Kids Cancer Center, Sydney Children's Hospital, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Nelune Comprehensive Cancer Center, Prince of Wales Hospital, Sydney, Australia
| |
Collapse
|
3
|
Groh AM, Moore CW, El-Warrak A, Seager SW, Power NE, Allman BL, Beveridge TS. Electroejaculation functions primarily by direct activation of pelvic musculature: Perspectives from a porcine model. TRANSLATIONAL RESEARCH IN ANATOMY 2018. [DOI: 10.1016/j.tria.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
4
|
At what price do we treat patients with testicular cancer? EJC Suppl 2013. [PMID: 26217142 PMCID: PMC4041547 DOI: 10.1016/j.ejcsup.2013.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
5
|
Ribeiro TM, Bertolla RP, Spaine DM, Fraietta R, Ortiz V, Cedenho AP. Sperm nuclear apoptotic DNA fragmentation in men with testicular cancer. Fertil Steril 2008; 90:1782-6. [PMID: 18068165 DOI: 10.1016/j.fertnstert.2007.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 08/06/2007] [Accepted: 08/06/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To verify whether sperm from patients with a seminoma and patients with a non-seminoma present with an increased rate of apoptotic DNA fragmentation, when compared with men without testicular cancer and who had fathered a child in the 2 years preceding the study. DESIGN Controlled prospective study. SETTING Patients referred to a sperm bank in an academic research environment. PATIENT(S) Men with a diagnosed seminoma, men with a diagnosed non-seminoma, both after orchiectomy and before adjuvant therapy, and men with proven paternity in the 2 previous years. MAIN OUTCOME MEASURE(S) Rate of nuclear apoptotic sperm DNA fragmentation as assessed by TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling) assay, classified as positive (with DNA fragmentation) or negative (without DNA fragmentation). RESULT(S) Of the 48 men with testicular cancer included in the study, 29 (60.4%) presented a non-seminoma and 19 (39.6%) a seminoma. Patients with non-seminoma presented with lower progressive sperm motility than the control group (57.4% and 66.3%, respectively), but both were still within normal ranges. Sperm concentration was lower in seminoma (31.2 x 10(6)/mL) and in non-seminoma (20.6 x 10(6)/mL) when compared with the control group (78.1 x 10(6)/mL), but values did not differ between the two testicular cancer groups. Sperm morphology was lower in patients with non-seminoma than in the control group (10% and 13.1%, respectively). Results for sperm nuclear apoptotic DNA fragmentation (mean; standard deviation) were 12.6%; 4.5% for the control group, 12.2%; 5.5% for the non-seminoma group, and 12.5%; 6.4% for the seminoma group. No differences were found between the three groups. CONCLUSION(S) Our results demonstrate that the presence of a seminoma or a non-seminoma is not associated with an increase in sperm apoptotic DNA fragmentation.
Collapse
Affiliation(s)
- Taísa Michelucci Ribeiro
- Department of Surgery, Division of Urology, Human Reproduction Section, São Paulo Federal University, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
6
|
Bashore L. Semen Preservation in Male Adolescents and Young Adults With Cancer: One Institution's Experience. Clin J Oncol Nurs 2007; 11:381-6. [PMID: 17623622 DOI: 10.1188/07.cjon.381-386] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Semen preservation is a feasible procedure for male adolescents and young adults who may become infertile as a result of cancer therapy. Treatment for several pediatric malignancies puts adolescents and young adults at a significant risk for fertility dysfunction. Eligible male adolescents and young adults (N = 32) treated from January 2004 to June 2005 at Cook Children's Medical Center were offered semen preservation at the time of diagnosis or presentation to the center for treatment. Fifteen (47%) young men were successful in semen preservation. Two (6%) adolescents did not participate because of parental refusal. Seven (22%) were too ill, and eight (25%) failed to produce an adequate sample. Several patients were not successful because of time constraints, lack of counseling, and parental anxiety. Efforts for success in semen preservation should include private discussions between nurses and adolescents. In addition, information on infertility needs to be given to families early in the diagnostic phase to provide them with an opportunity to ask questions.
Collapse
Affiliation(s)
- Lisa Bashore
- Cook Children's Medical Center, Fort Worth, TX, USA.
| |
Collapse
|
7
|
Brydøy M, Fosså SD, Klepp O, Bremnes RM, Wist EA, Wentzel-Larsen T, Dahl O. Paternity following treatment for testicular cancer. J Natl Cancer Inst 2005; 97:1580-8. [PMID: 16264178 DOI: 10.1093/jnci/dji339] [Citation(s) in RCA: 162] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies of fertility in men treated for testicular cancer have mainly addressed serum follicle-stimulating hormone levels and sperm parameters. We assessed post-treatment paternity among long-term survivors of testicular cancer. METHODS Men (n = 1814) who had been treated for unilateral testicular cancer in Norway during 1980 through 1994 were invited to participate in a national multi-center follow-up survey in 1998 through 2002. The participants were allocated to five groups according to the treatment received after orchiectomy, including treatment at relapse (surveillance, retroperitoneal lymph node dissection, radiotherapy, low-dose chemotherapy [i.e., < or = 850 mg cisplatin], and high-dose chemotherapy [i.e., > 850 mg cisplatin]). Cox proportional hazards analysis was used to assess predictive factors for post-treatment paternity. Statistical tests were two-sided. RESULTS A total of 1433 men were assessable, of whom 827 were fathers at diagnosis. Post-treatment conception was attempted by 554 men, among whom the overall 15-year actuarial post-treatment paternity rate was 71% (95% confidence interval [CI] = 66% to 75%) without the use of cryopreserved semen. This rate ranged from 48% (95% CI = 30% to 69%) in the high-dose chemotherapy group to 92% (95% CI = 78% to 98%) in the surveillance group (P < .001). The median actuarial time from diagnosis to the birth of the first child after treatment was 6.6 years overall but varied according to treatment. Assisted reproductive technologies were used by 22% of the couples who attempted conception after treatment. Dry ejaculation, treatment group, pretreatment fatherhood, and marital status were statistically significant independent predictors for post-treatment fatherhood, with dry ejaculation as the most important negative factor. CONCLUSIONS Although the overall paternity rate after treatment for testicular cancer was high, the ability to conceive and the time to conception reflected the intensity of treatment. These data may help inform patients about their future ability to father biological children.
Collapse
Affiliation(s)
- Marianne Brydøy
- Department of Oncology, Haukeland University Hospital, Bergen, Norway.
| | | | | | | | | | | | | |
Collapse
|
8
|
Agarwal A, Ranganathan P, Kattal N, Pasqualotto F, Hallak J, Khayal S, Mascha E. Fertility after cancer: a prospective review of assisted reproductive outcome with banked semen specimens. Fertil Steril 2004; 81:342-8. [PMID: 14967371 DOI: 10.1016/j.fertnstert.2003.07.021] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2003] [Revised: 07/08/2003] [Accepted: 07/08/2003] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the outcome of assisted reproduction techniques (ART) using cryopreserved semen from patients with cancer. DESIGN Prospective. SETTING Therapeutic semen banking program at a tertiary healthcare center. PATIENT(S) Twenty-nine men with cancer who cryopreserved their sperm before treatment at our facility from 1982 to 2001 and withdrew their samples for assisted reproduction (IUI, IVF, or intracytoplasmic sperm injection [ICSI]). INTERVENTION(S) Sperm bank records were used to identify the patients. Information on fertility potential indices was obtained from medical records and through interviews. Of the 29 patients, 9 had testicular cancer, 12 had Hodgkin's disease, and 8 had other types of cancer. MAIN OUTCOME MEASURE(S) Pregnancy and live births. RESULT(S) A total of 87 ART cycles (42 IUI, 26 IVF, and 19 ICSI) was performed. Of those cycles, 18.3% resulted in pregnancy (7% IUI, 23% IVF, and 37% ICSI), and 75% of the pregnancies resulted in a live birth (100% IUI, 83% IVF, and 57% ICSI). There was no significant difference in the outcomes when the results were stratified by type of ART and malignancy. None of the 11 infants who were born had congenital anomalies. CONCLUSION(S) Our findings emphasize the need for physicians to discuss the issue of semen cryopreservation with all men of reproductive age who have cancer before antineoplastic therapy is started.
Collapse
Affiliation(s)
- Ashok Agarwal
- Center for Advanced Research in Human Reproduction, Infertility and Sexual Function, Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
| | | | | | | | | | | | | |
Collapse
|
9
|
Patel MI, Motzer RJ, Sheinfeld J. Management of recurrence and follow-up strategies for patients with seminoma and selected high-risk groups. Urol Clin North Am 2004; 30:803-17. [PMID: 14680316 DOI: 10.1016/s0094-0143(03)00063-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Seminoma is characterized by high sensitivity to both radiation and chemotherapy. Localized recurrences in the retroperitoneum after surveillance for stage I can be treated with radiotherapy; however, multiple or large bulky retroperitoneal recurrences or systemic metastasis requires cisplatin-based chemotherapy. Salvage chemotherapy for those who recur after initial CR to induction chemotherapy is based on ifosfamide- and cisplatin-containing regimens. Incomplete response or failure after induction chemotherapy requires high-dose chemotherapy and stem cell rescue. Patients with seminoma need long-term follow-up because of the possibility of late recurrence and the risk of a second primary tumor.
Collapse
Affiliation(s)
- Manish I Patel
- Department of Urology, Memorial Sloan-Kettering Cancer Center, 353 E. 68th Street, New York, NY 10021, USA
| | | | | |
Collapse
|
10
|
Pasqualotto FF, Lucon AM, Sobreiro BP, Pasqualotto EB, Arap S. Effects of medical therapy, alcohol, smoking, and endocrine disruptors on male infertility. ACTA ACUST UNITED AC 2004; 59:375-82. [PMID: 15654492 DOI: 10.1590/s0041-87812004000600011] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Infertility affects up to 15% of the sexually active population, and in 50% of cases, a male factor is involved, either as a primary problem or in combination with a problem in the female partner. Because many commonly encountered drugs and medications can have a detrimental effect on male fertility, the medical evaluation should include a discussion regarding the use of recreational and illicit drugs, medications, and other substances that may impair fertility. With the knowledge of which drugs and medications may be detrimental to fertility, it may be possible to modify medication regimens or convince a patient to modify habits to decrease adverse effects on fertility and improve the chances of achieving a successful pregnancy. Concern is growing that male sexual development and reproduction have changed for the worse over the past 30 to 50 years. Although some reports find no changes, others suggest that sperm counts appear to be decreasing and that the incidence of developmental abnormalities such as hypospadias and cryptorchidism appears to be increasing, as is the incidence of testicular cancer. These concerns center around the possibility that our environment is contaminated with chemicals - both natural and synthetic - that can interact with the endocrine system.
Collapse
Affiliation(s)
- Fábio Firmbach Pasqualotto
- Department of Urology, Hospital das Clínicas, Faculty of Medicine, University os São PAulo, São Paulo, SP, Brazil.
| | | | | | | | | |
Collapse
|
11
|
Abstract
Testicular cancer is the most common solid tumour among young males aged 15-35 years. Cisplatin-based combination chemotherapy has changed the outlook of this disease. Disseminated testicular cancer, once uniformly fatal, now has a cure rate of more than 80% with combination chemotherapy. Systematic randomised trials have shown that cisplatin, etoposide and bleomycin (PEB) combination chemotherapy remains the mainstay of treatment. While there is a high cure rate with chemotherapy in patients with this disease, some long-term complications from chemotherapy have now been recognised, including secondary leukaemia, therapy-related solid tumours, nephrotoxicity, neurotoxicity, pulmonary toxicity, vascular toxicity and infertility. Etoposide, a DNA topoisomerase II inhibitor, is a significant risk factor for developing leukaemia; the risk appears to be correlated with the total dose given. Patients receiving cisplatin-based combination chemotherapy for testicular cancer also appear to have a higher relative risk for developing second non-germ cell malignancies; the greatest risks for therapy-related solid tumours were seen with a combination of radiation therapy plus chemotherapy. Long-term vascular toxicities associated with chemotherapy include Raynaud's phenomenon, acute myocardial infarction and cerebrovascular events. Bleomycin is thought to be the most important drug in the pathogenesis of Raynaud's phenomenon, while cisplatin is the most likely agent involved in myocardial infarction. Peripheral neuropathy is the most common form of neurotoxicity observed with cisplatin-based chemotherapy. Risk factors for the development of neural damage include a high cumulative dose of cisplatin, the use of vinblastine and the concomitant development of Raynaud's phenomenon. Cisplatin is also well known to cause significant nephrotoxicity. Approximately 25% of patients present with azoospermia after undergoing combination chemotherapy with a follow up of 2-5 years. Physician awareness of complications associated with chemotherapy is vital to maximise efficacy, minimise toxicity, and preserve quality of life after treatment. Sperm cryopreservation should be considered for patients who desire children. Close monitoring during therapy allows for the early diagnosis of complications, and close follow up of patients after the completion of therapy is necessary to monitor for relapse and development of long-term complications such as myelodysplastic syndrome and leukaemia. Despite these complications, given the potential for cure rates in this young group of patients, the benefits far outweigh the risks.
Collapse
Affiliation(s)
- Uzair B Chaudhary
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
| | | |
Collapse
|
12
|
Taksey J, Bissada NK, Chaudhary UB. Fertility after chemotherapy for testicular cancer. ARCHIVES OF ANDROLOGY 2003; 49:389-95. [PMID: 12893517 DOI: 10.1080/01485010390219917] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Disseminated testicular cancer has largely become curable with cisplatin-based chemotherapy. The prospect of fertility after treatment is an important consideration for both patients and clinicians. While there may be an irreversible impairment of spermatogenesis at a cumulative cisplatin dose of greater than 400 mg/m2, a low sperm count does not necessarily appear to prevent fatherhood. This review summarizes currently available data on the effects of chemotherapy on male fertility and steps that can be taken to preserve fertility in this patient population.
Collapse
Affiliation(s)
- J Taksey
- Department of Medicine and Urology, Medical University of South Carolina, Charleston, SC 29425, USA
| | | | | |
Collapse
|
13
|
Spermon JR, Kiemeney LALM, Meuleman EJH, Ramos L, Wetzels AMM, Witjes JA. Fertility in men with testicular germ cell tumors. Fertil Steril 2003; 79 Suppl 3:1543-9. [PMID: 12801557 DOI: 10.1016/s0015-0282(03)00335-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the prevalence of fertility or infertility in men before and after treatment for unilateral testicular cancer. The results were compared with the lifetime prevalence of infertility in the general population (20%-28%). DESIGN Survey. SETTINGS University referral center for testicular cancer. PATIENT(S) Two hundred twenty-six patients treated for testicular cancer. INTERVENTION(S) Questionnaire on fertility and fertility-related factors before and after treatment of disease. MAIN OUTCOME MEASURE(S) Prevalence of fertility before and after treatment for testicular cancer. RESULT(S) Before the cancer was diagnosed, 79 (66%) of 120 couples who attempted to conceive succeeded within 1 year. After treatment, 38 (43%) of 88 couples conceived within 1 year. Seven couples used cryopreserved sperm to conceive a child after treatment. The different treatment modalities did not significantly influence the outcome of patients' wish for children. Congenital malformations were recorded in approximately 4% of the children born before or after treatment. CONCLUSION(S) Although the majority of the patients with testicular cancer have a fulfilled wish with regard to children, it seems to be more difficult to father a child after treatment compared with the case in the general population. Because it is not possible to predict which patient will have fertility problems after treatment, cryopreservation should be offered to every testicular cancer patient. An increased risk for congenital malformations was not observed.
Collapse
Affiliation(s)
- J Roan Spermon
- Department of Urology, University Medical Center Nijmegen, The, Nijmegen, Netherlands.
| | | | | | | | | | | |
Collapse
|
14
|
Pasqualotto FF, Pasqualotto EB, Agarwal A, Thomas AJ. Detection of testicular cancer in men presenting with infertility. REVISTA DO HOSPITAL DAS CLINICAS 2003; 58:75-80. [PMID: 12845359 DOI: 10.1590/s0041-87812003000200004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Infertility is one of the less common presenting features associated with testicular tumors. We evaluated the histologic and biochemical findings, and pregnancy outcome in patients presenting with infertility who were found to have testicular tumors. METHODS Seven patients with infertility were found to have testicular cancer over a 15-year period. All patients had a testicular ultrasound evaluation. The indications for the ultrasound were testicular pain in 2 patients, suspicious palpable mass in 4, and to rule out the presence of germ cell neoplasia in a patient with carcinoma in situ detected on a previous biopsy. Physical exam, histological findings, hormonal levels, tumor markers, and pregnancy outcome results were recorded from the patients medical charts. RESULTS Two men had elevated serum follicle stimulant hormone and luteinizing hormone levels, 1 of them had an abnormally low serum testosterone level. Tumor markers were normal in all patients. In 4 patients the tumor was on the right side and in 3 on the left. The histological diagnoses were seminoma (n = 5), Leydig cell tumor (n = 1), and carcinoma in situ (n = 1). Of the 7 patients, 5 underwent adjuvant radiation therapy. Two patients had sperm cryopreserved. Follow up on fertility status was available in 6 cases. One patient has established a pregnancy and 5 did not achieve a pregnancy after treatment for their cancer. CONCLUSIONS Most of the men who have testicular cancer and male infertility have a seminona. Therefore, men who present with infertility should be thoroughly investigated to rule out such serious, concomitant diseases along with their infertility.
Collapse
Affiliation(s)
- Fabio Firmbach Pasqualotto
- Center for Advanced Research in Human Reproduction and Infertility, Urological Institute, Cleveland, EUA
| | | | | | | |
Collapse
|
15
|
Joly F, Héron JF, Kalusinski L, Bottet P, Brune D, Allouache N, Macé-Lesec'h J, Couëtte JE, Pény J, Henry-Amar M. Quality of life in long-term survivors of testicular cancer: a population-based case-control study. J Clin Oncol 2002; 20:73-80. [PMID: 11773156 DOI: 10.1200/jco.2002.20.1.73] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate quality of life and social problems in long-term survivors of testicular cancer. PATIENTS AND METHODS In 1998, 71 testicular cancer survivors (cases) identified from the Calvados General Tumor Registry were enrolled onto a case-control study. One hundred nineteen healthy control subjects (controls), matched by age and location of residence, were selected at random from electoral rolls. Three self-administered questionnaires were used: two health-related quality-of-life questionnaires (Short Form-36 and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 core questionnaires) and one life situation questionnaire. Specific questions concerning sexuality were also added. RESULTS With a mean follow-up of 11 years, health-related quality-of-life scores did not differ significantly between cases and controls, nor did general symptom scores. Psychosocial problems were reported equally by cases and controls. Cases reported more modification of sexual life (P =.04) with decreased sexual enjoyment (P <.01), decreased desire (P =.02), and infertility (P <.01). Cases did not report more divorce than controls; they reported fewer changes in relationships with friends (P =.03). Although a similar proportion of cases and controls were at work, cases expressed less ambitious professional plans (P =.002). Cases had greater difficulty in borrowing from banks (P <.001). CONCLUSION French long-term survivors of testicular cancer do not express more impairment of health-related quality of life or familial or professional life in comparison with healthy men. They did have more sexual life problems and found difficulty in borrowing from banks. This information should be used by practitioners to help their patients cope with their disease and return to normal life.
Collapse
Affiliation(s)
- F Joly
- Groupe Régional d'Etudes sur le Cancer (EA-1772), Centre François Baclesse, University of Caen-Basse, Normandie, 14076 Caen Cedex 5, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
The sequence of events encompassing ejaculation has been well described. Multiple disease processes can result in ejaculatory dysfunction. Evaluation and subsequent treatment of ejaculatory dysfunction is possible using behavioral, mechanical, and medical and surgical modalities. Further elucidation of ejaculation is now taking place at the molecular level.
Collapse
Affiliation(s)
- V A Master
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | | |
Collapse
|
17
|
Kobayashi H, Larson K, Sharma RK, Nelson DR, Evenson DP, Toma H, Thomas AJ, Agarwal A. DNA damage in patients with untreated cancer as measured by the sperm chromatin structure assay. Fertil Steril 2001; 75:469-75. [PMID: 11239525 DOI: 10.1016/s0015-0282(00)01740-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the relationship between sperm chromatin defects, evaluated by sperm chromatin structure assay (SCSA) and semen characteristics in cryopreserved semen specimens from patients diagnosed with various types of cancer. DESIGN Prospective study. SETTING Andrology laboratory at a tertiary care hospital. PATIENT(S) Cryopreserved semen samples from 12 healthy fertile men and 37 men diagnosed with cancer: testicular cancer (n = 20), Hodgkin's disease (n = 11), non-Hodgkin's disease (n = 4), and other neoplasm (n = 2). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The shift of green (native DNA) to red (denatured, single-stranded DNA) fluorescence in acridine orange-stained nuclei was measured and quantified using the expression alpha(t)(red fluorescence/[red + green fluorescence] per cell). Sperm DNA damage was correlated with classical semen characteristics. RESULT(S) Cancer patients as a group had significantly higher DNA damage when compared with controls. Specimens with high COMPalpha(t) values (percentage of sperm with denatured DNA) were present in all groups of cancer patients. No meaningful correlation was seen between the extent of DNA damage and classical semen measures. CONCLUSION(S) DNA damage in spermatozoa is prevalent in the majority of cancer patients. SCSA provides important information about the biochemical integrity of sperm DNA in men with cancer before their treatment.
Collapse
Affiliation(s)
- H Kobayashi
- Center for Advanced Research in Human Reproduction and Infertility, Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
OBJECTIVE To evaluate the value of aspirating sperm from the vas and epididymis at orchiectomy in azoospermic patients. DESIGN Retrospective clinical study. SETTING Tertiary care academic hospital. PATIENT(S) Three patients with known azoospermia who presented with testicular masses suspected to be cancerous. INTERVENTION(S) At orchiectomy, immediately after ligation of the spermatic cord, the contents of the epididymis and vas deferens were extracted into preserving media. MAIN OUTCOME MEASURE(S) Fertility rate. RESULT(S) Sperm retrieval was successful in all three patients. The mean total sperm count was 2.3 x 10(6)/mL with 20% motility. Intracytoplasmic injection of sperm harvested by using this method was successful in two couples, one of which delivered a healthy infant. CONCLUSION(S) Sperm can be aspirated from the vas deferens and epididymis at orchiectomy for preservation. In azoospermic patients, this procedure may salvage enough sperm for successful use in micromanipulation techniques. It may be worthwhile to perform sperm aspiration during orchiectomy for testis cancer in any patient with known or suspected infertility.
Collapse
Affiliation(s)
- J Baniel
- Urology Section, Rabin Medical Center, Belinson Campus, Petach Tikva, 41900 Israel.
| | | |
Collapse
|
19
|
MALIGNANT GERM CELL TUMOR OF THE CONTRALATERAL TESTIS AFTER RADIOTHERAPY FOR TESTICULAR INTRAEPITHELIAL NEOPLASIA. J Urol 2000. [DOI: 10.1097/00005392-200008000-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
DÖTSCH MARTIN, BRAUERS ANDREAS, BÜTTNER REINHARD, NOLTE-ERNSTING CLAUS, EBLE MICHAELJ, JAKSE GERHARD. MALIGNANT GERM CELL TUMOR OF THE CONTRALATERAL TESTIS AFTER RADIOTHERAPY FOR TESTICULAR INTRAEPITHELIAL NEOPLASIA. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67389-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- MARTIN DÖTSCH
- From the University Clinic of Urology, Institute of Pathology, Department of Radiology, and Clinic of Radiotherapy, Aachen, Germany
| | - ANDREAS BRAUERS
- From the University Clinic of Urology, Institute of Pathology, Department of Radiology, and Clinic of Radiotherapy, Aachen, Germany
| | - REINHARD BÜTTNER
- From the University Clinic of Urology, Institute of Pathology, Department of Radiology, and Clinic of Radiotherapy, Aachen, Germany
| | - CLAUS NOLTE-ERNSTING
- From the University Clinic of Urology, Institute of Pathology, Department of Radiology, and Clinic of Radiotherapy, Aachen, Germany
| | - MICHAEL J. EBLE
- From the University Clinic of Urology, Institute of Pathology, Department of Radiology, and Clinic of Radiotherapy, Aachen, Germany
| | - GERHARD JAKSE
- From the University Clinic of Urology, Institute of Pathology, Department of Radiology, and Clinic of Radiotherapy, Aachen, Germany
| |
Collapse
|
21
|
Sonneveld DJ, Koops HS, Sleijfer DT, Hoekstra HJ. Surgery versus surveillance in stage I non-seminoma testicular cancer. SEMINARS IN SURGICAL ONCOLOGY 1999; 17:230-9. [PMID: 10588851 DOI: 10.1002/(sici)1098-2388(199912)17:4<230::aid-ssu3>3.0.co;2-u] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Today, the standard treatment for patients with clinical Stage I non-seminomatous testicular germ cell tumors (NSTGCT) following orchidectomy is either primary retroperitoneal lymph node dissection (RPLND) or close surveillance with cisplatin-based polychemotherapy in case of a relapse. Both treatment modalities provide excellent overall survival rates up to 100%. Consequently, selection of the most appropriate management option is not primarily guided by survival considerations. The choice between the available options, each having its merits and its drawbacks, should be made based on a number of factors including treatment-related morbidity, views and expertise of the physician, patient preferences, the expected degree of patient compliance, and prognostic factor analysis. To date, the role of adjuvant chemotherapy as an alternative management option for patients with clinical Stage I NSTGCT at high risk of occult metastases is limited. This systemic treatment modality would be a realistic alternative if the reliability of prognostic factors to identify high-risk Stage I patients could be improved. This review addresses relevant issues in the management of patients with clinical Stage I NSTGCT to provide information that will allow a rational selection of the most appropriate management option.
Collapse
Affiliation(s)
- D J Sonneveld
- Department of Surgical Oncology, Groningen University Hospital, Groningen, The Netherlands
| | | | | | | |
Collapse
|
22
|
Sibert L, Rives N, Rey D, MacE B, Grise P. Semen cryopreservation after orchidectomy in men with testicular cancer. BJU Int 1999; 84:1038-42. [PMID: 10571631 DOI: 10.1046/j.1464-410x.1999.00348.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the feasibility of semen cryopreservation after orchidectomy in patients with testicular tumour. PATIENTS AND METHODS The quality of semen samples was investigated in 36 men with testicular tumour (mean age 31.7 years, range 20-49) who were referred to our infertility centre for semen cryopreservation. For each patient, the number of straws, semen volume, number of spermatozoa, and sperm motility before and after freezing were evaluated. RESULTS Fifteen patients (42%) banked sperm before and 21 (58%) after orchidectomy; the delay was >7 days in 19 patients (53%). The mean age, histological diagnosis and tumour stage did not differ significantly whatever the time of cryopreservation. Semen quality did not differ significantly in patients who cryopreserved sperm before or after orchidectomy and there were no significant differences in sperm values whatever the delay before preservation. Semen quality was the same in patients with seminoma or nonseminoma tumour. CONCLUSION These findings indicate that spermatogenesis of the contralateral testis is sufficient for successful semen cryopreservation after orchidectomy. Urologists should be encouraged to increase the awareness among oncology teams and patients about the new developments in preserving fertility for patients with cancer.
Collapse
Affiliation(s)
- L Sibert
- Department of Urology, Rouen University Hospital, Rouen, France.
| | | | | | | | | |
Collapse
|
23
|
Abstract
Cross-sectional studies have shown that long-term health-related quality of life is satisfactory in the majority of testicular cancer patients, in spite of slight to moderate physical morbidity (sexual dysfunction, infertility) in at least a third of them. Modern risk-adapted treatment of testicular cancer patients will hopefully decrease the long-term sequelae furthermore. Prospective studies are needed to identify those patients at increased risk of developing major physical or psychosocial problems, and to study the role of medical and psychological intervention at an early phase of the clinical course in these patients. The long-term investigation and follow-up of testicular cancer survivors provide useful information on survivorship problems in cured cancer patients in general.
Collapse
Affiliation(s)
- S D Fosså
- Department of Medical Oncology and Radiotherapy, Norwegian Radium Hospital, Oslo, Norway.
| | | | | |
Collapse
|