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Single adjuvant therapy course for early testicular cancer has no long-term effect on sperm count
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A single course of chemotherapy or radiotherapy after testicular cancer surgery appeared to have no significant long-term effect on sperm production among men with early-stage disease, according to results of a prospective study published in Annals of Oncology.
“We wanted to examine in more detail if postoperative treatment, given to decrease the risk [for] recurrence after the removal of the tumorous testicle, would affect the sperm count and sperm concentration long-term in [men with] testicular cancer with no spread of the disease,” Kristina Weibring, MD, of the department of oncology at Karolinska University Hospital in Stockholm, said in a press release. “This is important to find out, since treatment with one course of postoperative chemotherapy has been shown to decrease the risk [for] relapse substantially, thereby reducing the number of patients having to be treated with several courses of chemotherapy.”
Testicular germ cell cancer is the most common cancer in men aged 15 to 40 years, however, there is a lack of data regarding the effect of adjuvant treatment for early-stage disease on testicular function.
Researchers analyzed 182 men with clinical stage I testicular cancer who underwent orchiectomy and received adjuvant radiotherapy in 14 fractions of 1.8 Gy each — up to a total dose of 25.3 Gy — to the infradiaphragmal paraaortic and ipsilateral iliac lymph nodes (n = 70); one cycle of bleomycin, etoposide and cisplatin (BEP) in a 5-day regimen (n = 62); one cycle of carboplatin at an area under the curve of 7 (n = 22); or management by surveillance (n = 28).
Of the 182 men, 105 had seminoma (median age, 34 years) and 77 had nonseminoma (median age, 28 years).
Patients provided semen samples before adjuvant treatment and 6, 12, 24, 36 and 60 months after adjuvant treatment.
Results showed a significant drop in mean total sperm number and sperm concentration 6 months after radiotherapy. However, both sperm number and concentration subsequently recovered and increased in this group.
The only significant changes observed in the other groups included increases in mean sperm concentration at 12 months in the surveillance (P = .016), BEP (P = .02) and carboplatin (P = .04) groups. Levels remained rather stable over time among 119 men who provided three or more samples.
Researchers identified azoospermic patients (n = 11) in all groups except the BEP group. One azoospermic patient in the carboplatin group became normospermic during follow-up.
After 24 months, 70% to 90% of men showed normozoospermia in all but the carboplatin group, where 56% of men showed normozoospermia at 5 years.
The researchers still recommended sperm banking before orchiectomy regardless of treatment, as some men may have low sperm counts at diagnosis.
“With the results of this study, we can give the patients more adequate information on potential side effects from postoperative treatment,” Weibring said. “[Patients with] testicular cancer are often young men wanting to father children at some point, and we find, in many cases, that the patients are afraid of the potential risk [for] infertility caused by chemotherapeutic treatment. These findings should provide some reassurance to them.” – by John DeRosier
Disclosures: The authors report no relevant financial disclosures.
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