SEMEN QUALITY AND REPRODUCTIVE HORMONES BEFORE AND AFTER ORCHIECTOMY IN MEN WITH TESTICULAR CANCER:

Organ-sparing surgery does not lead to greater antisperm antibody levels than orchidectomy

OBJECTIVE

To assess a possible development of antisperm antibodies (ASA), present in a high percentage of infertile patients, after organ-sparing surgery for small testicular tumours, to identify any additional immunogenic effect of this procedure compared with standard orchidectomy.

PATIENTS AND METHODS

Samples of sera were assessed from 54 men who had had surgery between 2000 and 2005 for testicular tumour; the men were divided into two groups, i.e. group A (23) had had organ-sparing tumour resection and group B (31) had had inguinal orchidectomy. Other possible causes of ASA besides testicular tumour were excluded in all patients. The blood samples were obtained during follow-up visits and the circulating ASA in serum determined using an enzyme-linked immunosorbent assay.

RESULTS

The mean (range) tumour diameter was statistically significantly greater (P < 0.03) in group B, at 33.6 (2-130) mm, than in group A, at 12 (2-30) mm. There were significantly more stromal tumours in group A than group B (P < 0.02). Most importantly, the mean (range) ASA levels were not statistically significantly (P > 0.3) higher in group A, at 29 (15-59) U/mL, than in group B, at 24.8 (12-39) U/mL. There was also no statistically significant correlation between ASA levels and clinical stage, length of follow-up after therapy, patient age, tumour size and type of histology.

CONCLUSION

From these data, organ-sparing surgery does not lead to greater ASA levels than orchidectomy and patients are therefore at no greater risk of developing an autoimmune infertility.

Assessing the size and stage of testicular germ cell tumours: 1984-2003

OBJECTIVE

To assess the size and stage of testicular tumours on presentation in the period 1984-2002.

PATIENTS AND METHODS

Demographic details and information on staging on 550 patients treated at St. Bartholomew's and the Royal London Hospital in the period 1984-2002 were collected prospectively in the departmental database. Information on testicular size was obtained by reviewing the histopathology records, and the maximum dimension of the tumour as measured in the gross specimen was taken as the size of the testicular tumour.

RESULTS

The period 1984-2002 was divided into three intervals, i.e. 1984-95, 1996-98 and 1999-2002. The mean testicular tumour size in the three intervals decreased from 4 cm (162 tumours) to 3.2 cm (85) and 2.5 cm (72; P = 0.002, Student's t-test). The proportion of tumours of <2 cm on presentation also increased, from 11% to 14% and 23% in the three intervals, respectively, while the proportion of patients with stage 1 disease increased from 57%, to 63% and 77%, respectively.

CONCLUSIONS

The size of testicular tumours on presentation has shown a consistent decline in the last two decades, the mean size now being 2.5 cm. That 23% are now <2 cm raises the possibility of testis-preserving surgery in this young group of patients, who have an excellent prognosis, and therefore in the long-term issues such as psychological morbidity and natural fertility assume greater importance. There is a need for a randomized controlled trial to evaluate these issues.