Serum testosterone, LH, and FSH in patients with testicular cancer before and after radio- and chemotherapy

Sexual functioning after treatment for testicular cancer: comparison of treatment modalities

BACKGROUND

This retrospective study evaluates changes in sexual functioning after treatment for testicular cancer and investigates whether there is a relationship with different treatment modalities.

METHODS

A self-reported questionnaire was sent to 337 men who had been treated for testicular cancer at the University Hospital Groningen between 1977 and 1994. Medical information was obtained from the patient records.

RESULTS

A response was received from 287 men (85%); 264 patients were included in this study (78%). The mean patient age at follow-up was 37.7 years (range, 17-71 years). The mean follow-up period was 6.7 years (range, 0.25-18 years). Decrease in sexual functions was reported by 40% of patients (decrease in libido: 19%; arousal: 12% erection: 12.5%; orgasm: 19%; and ejaculation: 26%). Moreover, 23.5% of patients responding reported decreased sexual activity and 12.5% were dissatisfied with their sexual functioning. Patients with Stage II-IV nonseminoma who had been treated with polychemotherapy (PCT) with or without resection of residual retroperitoneal tumor mass (RRRTM) (PCT +/- RRRTM) reported a significantly sharper decrease in sexual functioning than patients who had been followed with a wait-and-see policy (W & S) (Stage I nonseminoma patients). It was noteworthy that patients treated by PCT alone reported more sharply decreased sexual functioning than patients treated by PCT + RRRTM. Patients treated by radiotherapy (Stage I-IIA seminoma) did not report findings significantly different from the W & S group.

CONCLUSIONS

Testicular cancer patients are at risk for reduced sexual functioning, especially when treated by chemotherapy, with or without resection of residual tumor. Although chemotherapy may influence somatic aspects of sexual functioning, it appears that psychologic factors arising from the confrontation with testicular cancer play a strongly mediating (if not determining) role.

Testicular function in eight patients with seminoma after unilateral orchidectomy and radiotherapy

Testicular function was monitored in eight patients with low stage seminoma who were treated with radiotherapy following unilateral orchidectomy. The absorbed gonadal radiation dose ranged from 15 to 157.5 rad. At 10-24 months after radiotherapy, serum hormone levels, sperm analysis, sperm penetration into zona-free hamster ova (HOP-test) and lymphocyte chromosome abnormalities were evaluated. Two patients were azoospermic with elevated serum levels of LH and FSH. The remaining six patients had slightly decreased (n = 3) or normal (n = 3) seminal parameters. Their HOP rates were within the normal range. A low incidence of polyspermy (i.e. only one penetrating sperm per ovum) was found in the patients, suggesting low penetrability of motile sperm. A highly significant correlation was found between sperm count or sperm penetrability and time post-irradiation. The results indicate that restitution of testicular function is time-dependent.

Post-treatment fertility in patients with testicular cancer. II. Influence of cis-platin-based combination chemotherapy and of retroperitoneal surgery on hormone and sperm cell production

Active sperm production was observed in 20 of 35 patients with testicular cancer 1 year after discontinuation of all treatment (retroperitoneal surgery only: 13; cis-platin-based chemotherapy (CVB) +/- other treatment: 22). The percentage of patients who regained spermatogenesis increased slightly after a further 1 to 2 years. Fourteen patients (of 121 under observation) impregnated their wives (after retroperitoneal surgery: 9; after CVB +/- other therapy: 5). The individual serum FSH values correlated significantly with the results of sperm analysis: an FSH value greater than or equal to 20 iu/l indicated azoospermia in 8 of 12 patients, whereas only 5 of 30 patients with FSH levels less than or equal to 12 iu/l were azoospermic. Serum testosterone and pituitary serum LH were virtually unaffected by the treatment. In conclusion, 1 to 3 years after cis-platin-based multi-modality treatment for testicular cancer, 50 to 60% of patients have active spermatogenesis and fatherhood can be achieved by a significant number of them.