Chapter 092. Testicular Cancer (Part 6)

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Fertility Infertility is an important consequence of the treatment of GCTs. Preexisting infertility or impaired fertility is often present. Azoospermia and/or oligospermia are present at diagnosis in at least 50% of patients with testicular GCTs. Ejaculatory dysfunction is associated with RPLND, and germ cell damage may result from cisplatin-containing chemotherapy. Nerve-sparing techniques to preserve the retroperitoneal sympathetic nerves have made retrograde ejaculation less likely in the subgroups of patients who are candidates for this operation. Spermatogenesis does recur in some patients after chemotherapy. However, because of the significant risk of impaired reproductive capacity, semen analysis and cryopreservation of sperm...

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Chapter 092. Testicular Cancer (Part 6) Fertility Infertility is an important consequence of the treatment of GCTs. Preexisting infertility or impaired fertility is often present. Azoospermia and/or oligospermia are present at diagnosis in at least 50% of patients with testicular GCTs. Ejaculatory dysfunction is associated with RPLND, and germ cell damage may result from cisplatin-containing chemotherapy. Nerve-sparing techniques to preserve the retroperitoneal sympathetic nerves have made retrograde ejaculation less likely in the subgroups of patients who are candidates for this operation. Spermatogenesis does recur in some patients after chemotherapy. However, because of the significant risk of impaired reproductive capacity, semen analysis and cryopreservation of sperm in a sperm bank should be recommended to all patients before treatment.
Further Readings Bosl GJet al: Testicular germ-cell cancer. N Engl J Med 337:242, 1997 [PMID: 9227931] ——— et al: Cancer of the testis, in Cancer: Principles and Practice of Oncology, 7th ed, VT DeVita et al (eds). Philadelphia, Lippincott Williams & Wilkins, 2005, pp 1269–1294 Chaganti RSK, Houldsworth J: Genetics and biology of human male germ cell tumors. Cancer Res 60:1475, 2000 [PMID: 10749107] International Germ Cell Cancer Consensus Group: International Germ Cell Consensus Classification: A prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol 15:594, 1997 Kondagunta GV et al: Etoposide and cisplatin chemotherapy for metastatic good-risk germ cell tumors. J Clin Oncol 23: 9290, 2005 [PMID: 16361627] Moore CJ et al: Management of difficult germ-cell tumors. Oncology 20:1565, 2006 [PMID: 17153909]
Motzer R et al: Sequential dose-intensive paclitaxel, ifosfamide, carboplatin, and etoposide salvage therapy for germ cell tumor patients. J Clin Oncol 18:1173, 2000 [PMID: 10715285] Sonpaude G et al: Management of recurrent testicular germ cell tumors. Oncologist 12:51, 2007 Bibliography Bosl GJ et al: Clinical relevance of the i(12p) marker chromosome in germ cell tumors. J Natl Cancer Inst 86:349, 1994 [PMID: 8308927] Chaganti RSK et al: Molecular biology of adult male germ cell tumors, in Comprehensive Textbook of Genitourinary Oncology, NJ Vogelzang et al (eds). Baltimore, Williams & Wilkins, 1999 De Santis M et al: 2-18 fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: An update of the prospective multicentric SEMPET trial. J Clin Oncol 22:1034, 2004
Einhorn LH et al: Evaluation of optimal duration of chemotherapy in favorable-prognosis disseminated germ cell tumors: A Southeastern Cancer Study Group protocol. J Clin Oncol 7:387, 1989 [PMID: 2465391] Feldman S et al: Low-risk metastatic gestational trophoblastic disease. Semin Oncol 22:166, 1995 [PMID: 7740318] Fossa SD et al: Risk of contralateral testicular cancer: A population-based study of 29,515 US men. J Natl Cancer Inst 97:1056, 2005 [PMID: 16030303] Jones WG et al: Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I Testicular Seminoma: A report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). J Clin Oncol 23:1200, 2005 [PMID: 15718317] Kondagunta V et al: Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. J Clin Oncol 23:6549, 2005 [PMID: 16170162] McGlynn KA et al: Trends in the incidence of testicular germ cell tumors in
the United States. Cancer 97:63, 2003 [PMID: 12491506] ——— et al: Relapse-free and overall survival in patients with pathologic stage II nonseminomatous germ cell cancer treated with etoposide and cisplatin adjuvant chemotherapy. J Clin Oncol 22:464, 2004 Motzer RJ, Bosl GJ: High-dose chemotherapy for resistant germ cell tumors: Recent advances and future directions. J Natl Cancer Inst 84:1703, 1992 [PMID: 1331482] Ryan CJ, Bajorin DF: Chemotherapy for good-risk germ-cell tumors. Semin Urol Oncol 20:244, 2002 [PMID: 12489057] Sheinfeld J et al: Surgery of testicular neoplasms, in Campbell's Urology, 8th ed, PC Walsh et al (eds). St. Louis, WB Saunders, 2002, pp 2920–2944