medwireNews: One course of adjuvant chemotherapy or radiotherapy does not appear to have a negative effect on sperm count or concentration over the long term in men with clinical stage I testicular cancer, suggests research.
Among 182 patients (aged 18–50 years) who received adjuvant therapy after having an orchiectomy at one of two Swedish institutions between 2001 and 2006, 38.5% received up to 25.2 Gy of radiation to the infradiaphragmal para-aortic and ipsilateral iliac lymph nodes, 34.1% received one cycle of bleomycin, etoposide, and cisplatin (BEP), 12.1% received one cycle of carboplatin, and 15.4% were managed by surveillance.
Sperm samples were collected post-orchiectomy but prior to initiating adjuvant therapy, and then at 6 months and yearly up to 5 years after completing treatment, with 65% of participants providing samples at three or more timepoints.
With the exception of the radiotherapy cohort, the average total sperm number and sperm concentration either increased or remained stable relative to post-orchiectomy values up to the 5-year mark in all other treatment groups.
Radiotherapy-treated men experienced “a distinct decrease” in both measures at 6 months post-orchiectomy, but the mean total sperm count and sperm concentration subsequently rose over the rest of the follow-up period, report the investigators in the Annals of Oncology.
They also note a decline in the average sperm count and concentration in the carboplatin group at 5 years, but caution that the finding “cannot be considered reliable due to the small number of patients delivering sperm samples at that time point.”
There did not appear to be significant intraindividual variation as evidenced by a longitudinal analysis of nine of the 119 men who provided at least three samples, in which average values for both measures generally remained stable over time.
The majority (84%) of patients in the BEP group were normospermic at the 12-month timepoint, and none experienced azoospermia at any point during the course of the study. By contrast, 5–18% of men in the radiotherapy, carboplatin, and surveillance groups were azoospermic at various timepoints.
“We found no clinically significant detrimental long-term effect in either [total sperm count] or [sperm concentration] irrespective of adjuvant [testicular cancer] treatment modality,” summarize Kristina Weibring, from Karolinska University Hospital in Stockholm, Sweden, and co-workers.
“This finding is important when discussing pros and cons of adjuvant treatment with the patient with regard to long-term side-effects on sperm parameters.”
Nonetheless, the team recommends that sperm banking before orchiectomy be offered, as future treatment requirements of patients cannot be predicted and “assisted reproductive measures may be necessary regardless of treatment given.”
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