Paternity and testicular function among testicular cancer survivors treated with two to four cycles of cisplatin-based chemotherapy

Eur Urol. 2010 Jul;58(1):134-40. doi: 10.1016/j.eururo.2010.03.041. Epub 2010 Apr 2.

Abstract

Background: Preserved fertility is an important issue for testicular cancer (TC) survivors.

Objective: Our aim was to examine any difference regarding paternity and testicular function following two, three, or four cycles of cisplatin-based chemotherapy for TC.

Design, setting, and participants: A national multicentre follow-up survey assessing morbidity among survivors of unilateral TC diagnosed from 1980 to 1994 was conducted during the period 1998 to 2002. Of the 1814 men invited, 1462 (80.6%) participated by responding to a mailed questionnaire and/or undergoing a clinical examination including laboratory assessments. The present study includes the 316 participants up to 65 yr of age treated with two to four cycles of standard cisplatin-based chemotherapy without additional treatment beyond surgery.

Measurements: Self-reported paternity following treatment for TC according to number of cycles was assessed among men who reported antegrade ejaculation and attempts at posttreatment conception (n=106). Kaplan-Meier analysis, log-rank test, and Cox regression were applied. Gonadal hormones (n=305-314) and sperm counts (n=71) by number of cycles were assessed by linear by linear association or Mann-Whitney tests.

Results and limitations: At median 12-yr follow-up, 80% (85 of 106) had succeeded in their attempts of achieving posttreatment paternity (two cycles: 100%; three: 83%; four: 76%; p=0.022). For all patients the 15-yr actuarial paternity rate was 85%. The association between posttreatment paternity and number of cycles remained significant in the multivariate analysis (p=0.032). High serum follicle-stimulating hormone values were more common with increasing number of cycles (p=0.037), but there were no differences in serum luteinising hormone, serum testosterone, or sperm counts. Few men treated with two cycles and a limited number of sperm samples are the main limitations of this study.

Conclusions: The prospects of future paternity after two to four cycles of cisplatin-based chemotherapy are good, and our data suggest that the prospects improve with decreasing number of cycles.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cisplatin / adverse effects
  • Cisplatin / therapeutic use*
  • Ejaculation / drug effects
  • Fertilization / drug effects
  • Follicle Stimulating Hormone / blood
  • Follow-Up Studies
  • Germinoma / drug therapy*
  • Germinoma / physiopathology
  • Germinoma / surgery
  • Health Surveys / statistics & numerical data
  • Humans
  • Infertility, Male / chemically induced
  • Luteinizing Hormone / blood
  • Male
  • Middle Aged
  • Multicenter Studies as Topic
  • Orchiectomy
  • Paternity*
  • Sperm Count / statistics & numerical data
  • Survivors / statistics & numerical data*
  • Testicular Neoplasms / drug therapy*
  • Testicular Neoplasms / physiopathology*
  • Testicular Neoplasms / surgery
  • Testis / physiology*
  • Testosterone / blood
  • Young Adult

Substances

  • Antineoplastic Agents
  • Testosterone
  • Luteinizing Hormone
  • Follicle Stimulating Hormone
  • Cisplatin