Current practices in fertility preservation in male cancer patients

Abstract

The incidence of a cancer diagnosis in children and young adolescents is increasing. With better treatments, the number of young cancer survivors living through reproductive age is increasing. Fertility preservation of these men and women has become essential and needs to be discussed prior to the start of cancer treatment. Here we review the current guidelines for male oncofertility patients and highlight some of the important gonadotoxic effects of chemotherapy, radiotherapy and surgery. Options for fertility preservation are also discussed along with resources that should be made available to all patients.

The protective effect of regucalcin against radiation-induced damage in testicular cells

“…Indeed, the testis is one of the most radiosensitive organs in the body because of the high mitotic rate of the germinal epithelium, with immature spermatogonia being extremely sensitive to the adverse effects of radiation [2].…”

“…Spermatogenesis is a complex and highly regulated process occurring in the seminiferous tubules of the testis that, after coordinated mitotic and meiotic divisions and cell differentiation events, culminates with the release of sperm into the lumen [1]. The germinal epithelium is very sensitive to exogenous damaging factors [2] due to its high mitotic rate, and for this reason, cancer treatments frequently have several adverse effects on male fertility, which implicate permanent or transitory impairment of spermatogenesis [3]. Concerning radiotherapy, it is also known both in rodents and humans that the extent of testicular injury is directly related to the dose of radiation delivered [4,5].…”

The Tissue-Sparing Effect of Spatially Fractionated X-rays for Maintaining Spermatogenesis: A Radiobiological Approach for the Preservation of Male Fertility after Radiotherapy

“…However, although radiotherapy has significantly evolved to have a high level of precision and accuracy, it can still result in temporary, long-term, or permanent gonadal toxicity in male patients [1,2]. In fact, spermatogenesis can be damaged by either direct testicular irradiation or the scattered doses received during the radiation treatment of cancers, such as prostate, bladder, rectal, and bone cancers [3]. Total doses to the testes exceeding 2.5 Gy that are delivered as multiple fractions generally produce permanent azoospermia, whereas single-fraction exposure requires doses greater than 6 Gy to produce the same effect [4,5].…”

Fertility maintenance in male oncological patients: current state and future perspectives

“…While some treatment regimens cause "only" reversible infertility, in 50-95 % of malignant oncological diseases, the infertility is permanent. This is the main reason why the discussion concerning the fertility maintenance should be of paramount importance in male oncological patients (Osterberg et al, 2014). It is underlined by the evidence that anticancer treatment is potentially harmful not only to testes directly, but also to hypothalamo-hypophyseal axis, which controls the function of the male gonads.…”