Long-term effects on sexual function and fertility after treatment of testicular cancer

Abstract

Summary This retrospective study evaluates the types and incidences of sexual disturbances and fertility distress in patients cured from testicular cancer and examines whether there is an effect resulting from different treatment modalities. A self-reported questionnaire was sent to 124 randomly selected patients who were treated at Hanover University Medical School between 1970 and 1993. Ninety-eight patients were included in the study, representing a response rate of 78%. All patients had been in complete remission (CR) for at least 24 months. The median age at diagnosis was 28 years (range 17-44). The median follow-up at the time of study was 12.0 years (range 2.8-25.6). Twenty patients (20%) had been treated for seminomatous and 78 patients (80%) for non-seminomatous germ cell tumours. Treatment included surveillance (7%), primary retroperitoneal lymph node dissection (RPLND) (13%), chemotherapy (CT) (33%), CT + secondary resection of residual retroperitoneal tumour mass (SRRTM) (43%) and infradiaphragmatic radiotherapy (4%). Patients receiving two treatment modalities (CT+SRRTM) reported more frequent an unfulfilled wish for children. Inability of ejaculation was clearly associated with RPLND and SRRTM. Subjective aspects of sexuality, like loss of sexual drive and reduced erectile potential, occurred only in a minority of patients after treatment. No abnormalities were observed concerning the course of pregnancies of partners. In conclusion, sexual dysfunction and infertility are common long-lasting sequelae in testicular cancer survivors affecting approximately 20% of patients. The relative risk for infertility appeared to be elevated for patients treated with the combination of CT+SRRTM. Twenty-one of 40 patients were able to fulfil their wish for children, and no congenital abnormalities were observed in these children.

Infertility rates following POMB/ACE chemotherapy for male and female germ cell tumours – a retrospective long-term follow-up study

“…However, we have not been able to show any dose-dependent correlation with risk of infertility in our study despite the findings of others (Pont and Albrecht, 1997). Never- (Hansen et al, 1990) 177 28 49 Various 8 3 5 (63%) Bisset (Bissett et al, 1990) 120 74 11 Various N/A 18 N/A Pont (Pont et al, 1996) 42 25 0 2 PEB a N/A 7 N/A Hartman (Hartmann et al, 1999) (Woolas et al, 1998). So, why are our findings different from those previously reported?…”

“…Thus, even before chemotherapy, 22 -63% of patients with testicular GCTs have reduced sperm counts at diagnosis (Hartmann et al, 1999;Fossa and Kravdal, 2000). Indeed, abnormal sperm counts may be associated with an increased risk of developing GCTs (Jacobsen et al, 2000).…”

Fertilité et aneuploïdies spermatiques après traitement par radiothérapie et/ou chimiothérapie pour cancer du testicule ou lymphome

“…Les cancers du testicule comme les lymphomes s'accompagnent souvent d'une alt6ration des param&res de sperme avant toute th6rapeutique [4,10,15,17]. Cette atteinte, dont la physiopathologie reste encore mal comprise, est un facteur d6favorable pour la r6cup6ration de la spermatogen~se apr~s traitement [8].…”

Sexual Dysfunction Among Cancer Survivors

“…Long-lasting sexual problems after therapy for testicular cancer are present in approximately one-fifth of patients undergoing treatment for testicular germ cell tumour. On the other hand, the majority of patients have not reported infertility or sexual dysfunctionrelated symptoms ( Hartmann et al, 1999). In a study by Huddart and colleagues, the testicular module of the EORTC QLQ C-30 Questionnaire, which consists of six questions directed at sexual function and sexual satisfaction and two additional questions about masculinity and concerns about fathering children, was used.…”