Journal of Cancer Survivorship

, Volume 4, Issue 3, pp 274–278 | Cite as

Fertility in patients treated for testicular cancer

Article

Abstract

Introduction

Testicular cancer affects men mostly in their reproductive age with a cure rate over 90% and fertility is one of the main concerns of survivors. To further elucidate the question of fertility after treatment for testicular cancer, we performed a survey in patients treated in our institution.

Patients and methods

We sent a questionnaire to patients treated for testicular cancer at our institute from 1976 to 2002 (n = 490) of whom 297 (60.6%) responded. We considered the patients to have conserved fertility if they had children after treatment without assisted reproductive technologies.

Results

Before treatment 119/297 (40.1%) of patients and after treatment 150/297 (50.5%) of patients tried to have children (p = 0.019). Of 119 patients who tried to have children before treatment for testicular cancer 98 (82.4%) succeeded and 74/150 (49.3%) were successful after treatment (p < 0.001). After treatment patients had 1–3 (median 1) children. The median time to birth of first child from diagnosis was 12 years. The post-treatment fatherhood in patients treated with surgery only (orchidectomy +/− retroperitoneal lymphnode dissection-RPLND) was 59%, in those with additional radiotherapy 68%, and chemotherapy 50% (p = 0.233). Fertility rate in patients where a non nerve sparing RPLND was performed was only 37%, 62% in patients with nerve sapring RPLND, and 77% in patients where RPLND was not performed (p < 0.0001).

Conclusion

Fertility rate after treatment for testicular cancer is reduced. From our data, the most important treatment modality that influences fertility is non nerve sparing RPLND that should be avoided whenever possible in order improve the quality of life our patients.

Keywords

Testicular cancer Fertility Retroperitoneal lymph node dissection Chemotherapy Radiotherapy 

Notes

Acknowledgements

The study was partially supported by grant J3-8924-302-97 of the Ministry of Higher Education, Science and Technology of Republic Slovenia.

We acknowledge the contribution of our pensioned colleagues, M. Stanovnik, MD who treated most of the patients included in this study and B. Jereb, MD, PhD for establishing the registry for late effects of cancer treatment of children and young adults.

References

  1. 1.
    Cancer incidence in Slovenia 1989, Ljubljana: Instutute of Oncology Ljubljnana, Cancer Registry of Republic of Slovenia, 1989.Google Scholar
  2. 2.
    Cancer incidence in Slovenia 2004, Ljubljana: Instutute of Oncology Ljubljnana, Cancer Registry of Republic of Slovenia, 2004.Google Scholar
  3. 3.
    Richiardi L, Pettersson A, Akre O. Genetic and environmental risk factors for testicular cancer. Int J Androl. 2007;30:230–40.CrossRefPubMedGoogle Scholar
  4. 4.
    Huyghe E, Plante P, Thonneau PF. Testicular cancer variations in time and space in Europe. Eur Urol. 2007;51:621–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Paduch DA. Testicular cancer and male infertility. Curr Opin Urol. 2006;16:419–27.CrossRefPubMedGoogle Scholar
  6. 6.
    Verdecchia A, Francisci S, Brenner H, et al. EUROCARE-4 Working Group. Lancet Oncol. 2007;8:784–96.CrossRefPubMedGoogle Scholar
  7. 7.
    Sabanegh ES, Ragheb AM. Male fertility after cancer. Urology. 2009;73:225–31.CrossRefPubMedGoogle Scholar
  8. 8.
    Fosså SD, Magelssen H. Fertility and reproduction after chemotherapy of adult cancer patients: malignant lymphoma and testicular cancer. Ann Oncol. 2004;15 Suppl 4:iv259–65.PubMedGoogle Scholar
  9. 9.
    Mitwally MF. Ferility preservation and minimizing reproductive damage in cancer survivors. Expert Rev Anticancer Ther. 2007;7:989–1001. Review.CrossRefPubMedGoogle Scholar
  10. 10.
    Byrne J, Mulinhill JJ, Myers MH, et al. Effects of treatment on fertility in long-term survivors of childhood or adolescent cancer. N Engl J Med. 1987;317:1315–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Fosså SD, Kravdal O. Fertility in Norwegian testicular cancer patients. Br J Cancer. 2000;82:737–41.CrossRefPubMedGoogle Scholar
  12. 12.
    Fosså SD. Long-term sequelae after cancer therapy—survivorship after treatment for testicular cancer. Acta Oncol. 2004;43:134–41. Review.CrossRefPubMedGoogle Scholar
  13. 13.
    Dubin L, Amelar RD. Etiologic factors in 1294 consecutive cases of male infertility. Fertil Steril. 1971;22:469–74.PubMedGoogle Scholar
  14. 14.
    Douchez J, Droz JP, Desclaux B, et al. Quality of life in long-term survivors of nonseminatous germ cell testicular tumors. J Urol. 1993;149:498–501.PubMedGoogle Scholar
  15. 15.
    Howards SS. Current concepts: treatment of male infertility. N Engl J Med. 1995;332:312–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Narajan P, Lange PH, Fraley EE. Ejaculation and fertility after extended retroperitoneal lymph node dissection for testicular cancer. J Urol. 1982;127:685–8.Google Scholar
  17. 17.
    Nijman JM, Jager S, Boer PW, Kremer J, et al. The treatment of ejaculation disorders after retroperitoneal lymph node dissection. Cancer. 1982;50:2967–71.CrossRefPubMedGoogle Scholar
  18. 18.
    Sogani PC. Evolution of the management of stage I nonseminomatous germ-cell tumors of the testis. Urol Clin North Am. 1991;18:561–73.PubMedGoogle Scholar
  19. 19.
    Foster SD, McNulty A, Rubin LR, et al. The fertility of patients with clinical stage I testis cancer managed by nerve sparing retroperitoneal lymph node dissection. J Urol. 1994;152:1139–43.PubMedGoogle Scholar
  20. 20.
    Gandini L, Sgrò P, Lombardo F, et al. Effect of chemo- or radiotherapy on sperm parameters of testicular cancer patients. Hum Reprod. 2006;21:2882–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Howell SJ, Shalet SM. Spermatogenesis after cancer treatment: Damage and recovery. J Natl Cancer Inst Monogr. 2005;34:12–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Pont J, Albrecht W. Fertility after chemotherapy for testicular germ cell cancer. Fertil Steril. 1997;68:1–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Taksey J, Bissada NK, Chaudhary UB. Fertility after chemotherapy for testicular cancer. Arch Androl. 2003;49:389–95.CrossRefPubMedGoogle Scholar
  24. 24.
    Halperin EC, Perez CA, Brady LW. Principles and practice of radiation oncology, 5th ed, Wolters Kluwer/Lippincott Williams&Wilkins 2008: 1513–1515.Google Scholar
  25. 25.
    Thonneau P, Marchand S, Tallec A, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988–1989). Hum Reprod. 1991;6:811–6.PubMedGoogle Scholar
  26. 26.
    Baker JA, Buck GM, Vena JE, et al. Fertility patterns prior to testicular cancer diagnosis. Cancer Causes Control. 2005;16:295–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Syse A. Does cancer affect marriage rates? J Cancer Surviv. 2008;2:205–14.CrossRefPubMedGoogle Scholar
  28. 28.
    Huddart RA, Norman A, Horwich A, et al. Fertility, gonadal and sexual function in survivors of testicular cancer. Br J Cancer. 2005;93:200–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Brydøy M, Fosså SD, Olbjørn K, et al. Paternity following treatment for testicular cancer. J Natl Cancer Inst. 2005;97:1580–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Hartmann JT, Albrecht C, Schmoll HJ, et al. Long-term effects on sexual function and fertility after treatment of testicular cancer. Br J Cancer. 1999;80:801–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Cvancarova M, Samuelsen SO, Magelssen H, et al. Reproduction rates after cancer treatment: Experiences from the Norwegian Radium hospital. J Clin Oncol. 2009;27:334–43.CrossRefPubMedGoogle Scholar
  32. 32.
    Howell SJ, Shalet SM. Testicular function following chemotherapy. Hum Reprod Update. 2001; Jul–Aug 7: 363–369. Review.Google Scholar
  33. 33.
    Colpi GM, Contalbi GF, Nerva F, et al. Testicular function following chemo-radiotherapy. Eur J Obstet Gynecol Reprod Biol. 2004;113 Suppl 1:S2–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Shalet SM. Effect of irradiation treatment on gonadal function in men treated for germ cell cancer. Eur Urol. 1993;23:148–51.PubMedGoogle Scholar
  35. 35.
    Huyghe E, Matsuda T, Daudin M, et al. Fertility after testicular cancer treatments. Results of a large multicenter study. Cancer. 2004;100:732–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department for Medical OncologyInstitute of Oncology LjubljanaLjubljanaSlovenia

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