Effect of Adjuvant Treatment for Early Testicular Cancer on Reproductive Potential
Men with early-stage testicular cancer can safely receive one course of adjuvant chemotherapy or radiotherapy without it having a long-term effect on their reproductive potential, according to a study published by Weibring et al in Annals of Oncology.
Although it is known already that several rounds of chemotherapy or high doses of radiotherapy given to men with more advanced testicular cancer can reduce sperm count and concentration, it has been unclear whether a single cycle of chemotherapy or radiotherapy would have a similar effect in men with stage I disease.
First study author Kristina Weibring, MD, of the Karolinska University Hospital, said, “We wanted to examine in more detail if postoperative treatment given to decrease the risk of recurrence after the removal of the tumorous testicle would affect the sperm count and sperm concentration long-term in [patients with] testicular cancer with no spread of the disease. To our knowledge, no such study has been done before.”
“This is important to find out, since treatment with one course of postoperative chemotherapy has been shown to decrease the risk of relapse substantially, thereby reducing the number of patients having to be treated with several courses of chemotherapy,” Dr. Weibring said.
Study Methods
The study included 182 men aged between 18 and 50 diagnosed with stage I testicular cancer who had had an orchiectomy within the past 5 years. Patients took part in the study between 2001 and 2006, and they were treated either in Stockholm or Lund. After surgery, they received radiotherapy (14 fractions of 1.8 Gy each, up to a total dose of 25 Gy) or one course of chemotherapy, or were managed by surveillance. They provided semen samples after orchiectomy but before further treatment, and then 6 months, 1 year, 2 years, 3 years, and 5 years thereafter. From 2006 onwards, radiotherapy was no longer used as a standard treatment in Sweden because of the risk of causing secondary cancer.
Findings
“We found no clinically significant detrimental long-term effect in either total sperm number or sperm concentration, irrespective of the type of postoperative treatment received,” said Dr. Weibring. “Among men who received radiotherapy, there was a distinct decrease in average sperm number and concentration 6 months after treatment, though not in those who received chemotherapy. However, sperm number and concentration recovered in the radiotherapy group after 6 months, and continued to increase in all groups up to 5 years after treatment.”
In 119 patients delivering three or more samples, values in total sperm number and sperm count were rather stable over time. Azoospermic patients (n = 11) were observed in most treatment groups, except for a group treated with adjuvant bleomycin, etoposide, and cisplatin. During follow-up, one azoospermic patient belonging to the group treated with carboplatin became normospermic.
“I am very excited to see these results, as I wasn’t expecting sperm to recover so well after postoperative treatment,” Dr. Weibring said. “I didn’t expect as negative an effect as if the patient had received many courses of chemotherapy, since it is much more toxic, but I was not sure how much the sperm would be affected by one course.”
“With the results of this study, we can give the patients more adequate information on potential side effects from postoperative treatment,” she continued. “[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 of infertility caused by chemotherapeutic treatment. These findings should provide some reassurance to them.”
Dr. Weibring concluded, “Our results are promising, but more studies are needed, and we still recommend sperm banking before orchiectomy as a number of patients may have low sperm counts at the time of diagnosis that persists after postoperative treatment. In addition, the type of testicular cancer and whether or not it will need further treatments are unknown factors before the orchiectomy. Assisted reproductive measures may be necessary for these patients, regardless of any treatment given.”
Disclosure: The study authors' full disclosures can be found at academic.oup.com.
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