Impact of chemotherapy and radiotherapy for testicular cancer on spermatogenesis and sperm DNA a multicenter prospective study from CECOS Network

Capsule:
Adjuvant treatments for testicular germ cell tumors have drastic effects on spermatogenesis and sperm chromatin quality; pretreatment values were recovered >12 months after >2 BEP cycles or after radiotherapy.

Authors:
Louis Bujan, M.D., Ph.D., Marie Walschaerts, Ph.D., Nathalie Moinard, D.Pharm., Sylvianne Hennebicq, M.D., Ph.D., Jacqueline Saias, M.D., Florence Brugnon, M.D., Ph.D., Jacques Auger, M.D., Ph.D., Isabelle Berthaut, Ph.D., Ethel Szerman, Ph.D., Myriam Daudin, M.D., Nathalie Rives, M.D., Ph.D.

Volume 100, Issue 3, Pages 673-680.e2, September 2013

Abstract:

Objective:
To determine the consequences of adjuvant testicular germ cell tumor treatment (TGCT) on sperm characteristics and sperm DNA, and to evaluate the predictors of sperm recovery.

Design:
Multicenter prospective longitudinal study of patients analyzed before treatment and after 3, 6, 12, and 24 months.

Setting:
University hospitals.

Patient(s):
One hundred twenty-nine volunteer TGCT patients and a control group of 257 fertile men.

Intervention(s):
Routine semen analyses, sperm DNA, and chromatin assessments.

Main Outcome Measure(s):
Comparisons of mean sperm characteristics before and after treatment, with sperm recovery analyzed by the Kaplan-Meier method.

Result(s):
The quantitative and qualitative sperm characteristics decreased after treatment, with lowest values at 3 and 6 months and with variations according to treatment type. The mean total sperm count recovered to pretreatment values at 12 months after treatment after two or fewer bleomycin, etoposide, and cisplatin (BEP) cycles, but not after radiotherapy or more than two BEP cycles. Only the treatment modalities and pretreatment sperm production were related to recovery of the World Health Organization reference sperm values. An increased proportion of patients had elevated high sperm DNA stainability at 6 months after radiotherapy.

Conclusion(s):
Adjuvant treatments for testicular germ cell tumor have drastic effects on spermatogenesis and sperm chromatin quality. These new data on both the recovery period according to treatment modalities and the post-treatment chromatin status of sperm are useful tools for counseling patients wishing to conceive.

  • José Martínez-Jabaloyas

    Congratulations to the authors for
    this interesting paper. The number of patients included and the periodic
    controls performed provide important information about the evolution of seminal
    parameters in patients with testicular germ cell tumours. It would be helpful
    to know the risk factors for permanent azoospermia after treatment, but I think
    that the low number of patients remaining azoospermics at 24 months difficult
    to know this. It is curious that no patient was azoospermic previous to
    treatment because the close relationship between testicular cancer and abnormal
    spermatogenesis. In the other hand, if a patient needs an assisted reproductive
    technique after chemotherapy, is it preferable to use the semen cryopreserved
    previous to treatment? I’d like to know the opinion of the authors.

  • Very nice large cohort review of the effects of radiation or chemotherapy for testicular GCT. This adds additional weight to having couples wait 1-2 years at attempts of conception after treatment with the above modalities.

    It is reassuring that men that have undergoing treatment for testicular cancer will continue to have improvements in their SA and fertility potential up to and beyond 2 years after treatment if they do not have the significant risk factors discussed in the article.

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