Post-treatment paternity in testicular cancer survivors: Do demographic variables matter?

Few commonly available factors are known which independently of treatment are associated with post- diagnosis paternity in Testicular Cancer Survivors (TCSs). In TCSs and age-matched controls we assessed the associations between first-time post TC paternity and respectively the level of pre-diagnosis paternity and diagnostic age.

Using data from the Medical Birth Registry of Norway paternity was assessed during 30 post-diagnosis years in 1062 tumour-free TCSs, (treatment:1980-1994) and 10620 age-matched controls. Analyses comprised post-orchiectomy treatment type (loco-regional versus systemic), diagnostic age (<30 versus ≥30 years), number of pre-diagnosis children (0, 1 versus ≥2) and calender year of TC diagnosis (≤1987 versus ≥1988).

Kaplan-Meier estimates, log-rank tests, Cox regression analyses; significance level: p < 0.05 RESULTS: 30 years after the TC diagnosis 45% of the TCSs had fathered ≥ 1 post-TC child (controls: 55%; p < 0.001), Post-TC paternity increased during treatment de-escalation, Compared to pre-TC paternity of one child, pre-diagnosis childlessness (HR: 0.58;[55-0.62]) or fatherhood of ≥ 2 pre-TC children (HR: 0.34;[0.32-0.37]), as well as diagnostic age of ≥ 30 years (HR: 0.40; [0.38-0.43]) reduced post-TC fatherhood. 23% of the TCSs remained finally childless. (Controls: 17%; p < 0.001). Immortal time bias represents a limitation of this study.

TCSs can be informed about the generally favourable probability of post-TC fatherhood at least once.The probability of post-TC paternity is, however,slightly lower in TCSs than in controls, even after de-escalated treatment. During post-TC paternity counselling age at diagnosis and the number of pre-diagnosis children should be considered together with treatment type and intensity.