NEW YORK, Jan 03 - Testicular cancer is a
disease that commonly strikes young men, making the effects of treatment on
fertility an important concern. Now from Norway come results of a study looking
at how well some of these patients recover their ability to produce sperm and
what options are open to them.
Dr. Sophie D. Fossa, of The Norwegian Radium Hospital in Oslo, and
colleagues studied 60 cancer patients who underwent a surgical procedure called
orchiectomy, where the cancerous testicle is removed. Most of the men had
regained their normal sperm counts after surgery and almost half became
fathers, representing 78 percent of those who were trying to have a child, according
to the report in the January issue of The Journal of Urology.
But Fossa noted, it is not unusual for some patients to experience decreased
sperm production in the remaining testicle following surgery. "Ten or 15
years ago (many) urologists thought this type of reduced (sperm production)
always was permanent. Therefore, aggressive further chemotherapy would be more
justified based on the assumption that these men would, in any case, not be
able to father a child," the researcher told Reuters Health.
As a consequence, she continued, the type of surgical procedure often
performed in the past "destroyed the ejaculatory functions."
But Fossa and her colleagues found that even some patients with initially
low sperm counts will experience a "transient" period of normal sperm
levels for perhaps a year after surgery.
"Today's surgeons and oncologists have to consider this spontaneous
recovery when planning and timing (the) treatment after orchiectomy in a
patient who most probably does not have any metastases," Fossa explained.
Metastases are secondary cancers that occur when cancer spreads to other sites
in the body.
These metastases-free patients may be good candidates for what is termed a
"surveillance policy." That is, no further treatment after the
Fossa also pointed out that patients who have low sperm counts going into orchiectomy
were often not given the option to bank their sperm "because of the low
success rate of assisted fertilization. This has changed with better methods of
in vitro fertilization."
Fossa suggested that patients who are on surveillance should be offered
"multiple sperm banking" in the year after their orchiectomy, to take
advantage of the temporary rise in sperm production "even in cases who may
seem to be 'hopeless' at their first sperm analysis."
Moreover, she added, patients should ask for "at least one sperm
analysis at the time of diagnosis, which should be repeated if no further
treatment is given and the initial sperm count was low."
In her view, it is important for patients to know that "correct timing
and sperm banking may give a true chance of post-orchiectomy fatherhood."
SOURCE: The Journal of Urology 2001;165:93-96.
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