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Gonadal function in men with testicular cancer
P M Petersen1, A Giwercman, N E Skakkebaek
1Department of Growth and Reproduction, Finsencenter, Copenhagen University Hospital, Rigshospitalet, Denmark.
Seminars in Oncology
|April 30, 1998
Summary
Testicular germ cell cancer (TGCC) and its treatments significantly impair male reproductive function, affecting spermatogenesis and Leydig cell function. Fertility preservation through semen cryopreservation before treatment is crucial.
Area of Science:
- Reproductive Endocrinology
- Oncology
- Male Reproductive Health
Background:
- Testicular germ cell cancer (TGCC) development may share etiological factors with other testicular dysfunctions, including infertility and cryptorchidism.
- Men with gonadal dysfunctions like testicular dysgenesis and androgen insensitivity syndrome exhibit an increased risk of developing testicular cancer.
- Hormonal factors are implicated in the etiology of testicular cancer, with common links to male reproductive health abnormalities.
Purpose of the Study:
- To review the impact of testicular germ cell cancer (TGCC) on gonadal function.
- To assess the effects of cancer treatments on spermatogenesis and Leydig cell function.
- To provide guidance on fertility preservation and reproductive health counseling for TGCC patients.
Main Methods:
- Literature review of current knowledge on TGCC and gonadal function.
- Analysis of epidemiological and clinical data on TGCC etiology and male reproductive health.
- Evaluation of treatment effects (orchidectomy, radiotherapy, chemotherapy) on spermatogenesis and Leydig cells.
Main Results:
- TGCC is associated with impaired spermatogenic and Leydig cell function even before treatment.
- Cancer treatments, including chemotherapy and radiotherapy, cause dose-dependent impairment of spermatogenesis, with potential for long recovery times.
- While most patients maintain sufficient androgen production, some experience testosterone deficiency; chemotherapy's effect on Leydig cells is dose-dependent.
Conclusions:
- Effective fertility preservation strategies for TGCC patients primarily involve semen cryopreservation before treatment, as oncofertility protection trials have been unsuccessful.
- Men with TGCC require comprehensive counseling regarding semen cryopreservation, potential spermatogenesis recovery, fertility, and possible androgen replacement therapy.
- Understanding the shared etiology between TGCC and other testicular dysfunctions highlights the importance of reproductive health monitoring in affected individuals.