Testicular function in adult males surviving childhood malignancy

Testicular function was studied in 109 males aged 16 to 25 years surviving leukemia or solid tumors in childhood. The mean follow-up time was 10.3 years after diagnosis. Of the patients studied, 18 had received testicular radiotherapy, 35 central nervous system radiotherapy, and 3 total body radiotherapy. Twenty-one patients presented with incomplete puberty and 85 presented with small testicles (< 20 mL). Of the 109 patients, 43 had elevated concentrations of serum follicle-stimulating hormone (FSH) or serum FSH and leutinizing hormone. Compared with survivors of solid tumors, the patients surviving acute lymphoblastic leukemia (ALL) had inferior testicular status. This was also the case even when those treated with testicular radiotherapy were excluded. Twenty-six patients were receiving testosterone substitution therapy at the time of the study; 25 of whom were survivors of ALL. The probability of normospermia was 50% if both testicular volume and serum FSH were within normal limits and 0% if they were abnormal. Of the 86 patients over 18 years of age, 16 had evidence of normal testicular function. Of these 16, 8 patients had normospermia, only 1 of whom was a survivor of ALL. These findings suggest that ALL survivors have inferior testicular function compared with patients surviving solid tumors. Our findings confirm that testicular radiotherapy inevitably results in testicular damage, the degree of which is generally severe but variable in some individuals. We were unable to find an explanation for the individual tolerance to therapy, eg, age at diagnosis.