Paternity in Patients with Bilateral
Testicular Germ Cell Tumors

Heidenreich, Axel; Vorreuther, R.; Neubauer, Stephan; Zumbé, J.; Uh, Engelmann

doi:10.1159/000474459

Cited by 24 publications

(12 citation statements)

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“…It is well known that fertility is usually much reduced in men with testicular cancer and patients having CIS are expected to have an even worse semen quality 13 . However, although unusual, paternity was reported in men with BTGCT and even in a man with seminoma and CIS in a solitary testis treated with partial orchiectomy 9,10,14 10 but the risk of relapse is minimal in the absence of CIS, as in our case.…”

Section: Discussionsupporting

confidence: 52%

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Testis sparing surgery for the treatment of a sequential bilateral testicular germ cell tumor

et al. 2001

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Standard therapy of sequential bilateral testis cancer is generally considered to be orchiectomy. We present a case of sequential bilateral testicular germ cell tumor treated with testis sparing surgery. The patient was disease free 50 months after surgery without local recurrence or distant metastases. Testis sparing surgery provides a better quality of life and may be considered a safe, feasible alternative in the treatment of carefully selected patients with bilateral testicular germ cell tumor.

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Section: Discussionsupporting

confidence: 52%

“…Since the prognosis of patients with BTGCT has highly improved with the advent of modern therapeutic options, preservation of the testis in young men has become an important issue. Thus, a less aggressive surgical approach for the treatment of BTGCT has evolved and testis sparing surgery has been encouraged by some authors 5–11 6,7 .…”

Section: Discussionmentioning

confidence: 99%

Testis sparing surgery for the treatment of a sequential bilateral testicular germ cell tumor

et al. 2001

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“…58,64 eaU guidelines state that the most appropriate radiotherapy regimen to eliminate CIS is a total dose of 20 Gy (single doses of 2Gy, five times a week for 2 weeks). [65][66][67][68] Such a dose might compromise androgen production in up to 25% of men. 69 Thus, for preservation of testosterone production, radiation doses <20 Gy have been investigated.…”

Section: Management Of Carcinoma In Situmentioning

confidence: 99%

Organ-sparing approaches for testicular masses

2010

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Organ-sparing approaches are currently practiced in urology for many malignancies. Partial orchiectomy of germ cell tumors (GCT) provides potential benefits over radical surgery by reducing the need for androgen substitution, lessening psychological stress, and preserving fertility, with a durable cure rate. Furthermore, many testicular lesions detected clinically or by ultrasonography will be benign, in which case radical orchiectomy represents overtreatment. Partial orchiectomy for benign lesions allows preservation of endocrine and exocrine function, and reduced risk of local recurrence. However, selection criteria are not clear and one must always be suspicious that a GCT might exist. Carcinoma in situ that remains in the salvaged testicle is a challenge to treat. Radiation therapy is an option, although there is a high chance that patients will subsequently require hormonal replacement. Partial orchiectomy should be undertaken only in selected patients--men with bilateral testicular cancer or GCT in a solitary testis--if the size and location of the mass are amenable to surgery. Informed patient consent discussing radical orchiectomy as the gold standard is mandatory, and discussion of the risks associated with CIS and its treatment, as well as the need for androgen supplementation are paramount. Alternative strategies of organ preservation, such as radiotherapy, HIFU and chemotherapy, might be appropriate treatment options in the future. However, the safety and efficacy of these procedures needs to be demonstrated in comparison with partial orchiectomy in larger and prospective studies with longer follow-up.

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“…As treatment of ITGCN also involves destruction of the normal spermatogonia, patients who undergo radiation therapy to a solitary testis are rendered infertile. There is evidence that many patients with ITGCN in a solitary testis are infertile even prior to treatment,[107108] though paternity has been documented[109] and improvement in spermatogenesis has been demonstrated following the removal of unilateral TGCTs. [110] Leydig cell function appears to be affected at 20 Gy as up to 25% require hormone supplementation.…”

Section: Treatmentmentioning

confidence: 99%

Intratubular germ cell neoplasms of the testis and bilateral testicular tumors: Clinical significance and management options

Masterson

2010

Indian J Urol

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Objectives:Intratubular germ cell neoplasia (ITGCN) is the precursor lesion for invasive testicular germ cell tumors (TGCTs) of adolescents and young adults. The rising incidence of these tumors has prompted a rigorous investigation of the etiology, diagnosis and management of ITGCN. Bilateral testicular cancer is closely linked with ITGCN, as patients with unilateral testicular cancer are at the highest risk for a future malignancy in the contralateral testicle.Methods:A literature review directed at ITGCN and bilateral testis cancer was performed using the Medline/PubMed database. Our review focused on the pathogenesis, risk factors, diagnosis and treatment regimens utilized.Results:Major advances have been made in the understanding of ITGCN over the past 30 years. There is evidence that TGCTs arise from ITGCN, ITGCN is closely related to fetal gonocytes, and that events in pre- and perinatal period may result in abnormal persistence of fetal gonocytes leading to ITGCN and subsequent TGCT. Controversy exists regarding the need to biopsy men at increased risk of TGCT, as well as the best approach to managing patients with known ITGCN. Bilateral testicular cancer has excellent outcomes in the current era of platinum-based chemotherapy.Conclusion:The optimal management of patients at risk for ITGCN and future TGCT is still a matter of debate. Individualization of management, including biopsy and treatment, should be based on risk factors for TGCT, compliance with potential surveillance, and patient preferences particularly with regard to fertility.

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Paternity in Patients with Bilateral Testicular Germ Cell Tumors

Cited by 24 publications

References 1 publication

Testis sparing surgery for the treatment of a sequential bilateral testicular germ cell tumor

Testis sparing surgery for the treatment of a sequential bilateral testicular germ cell tumor

Organ-sparing approaches for testicular masses

Intratubular germ cell neoplasms of the testis and bilateral testicular tumors: Clinical significance and management options

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