04 May 2010

Prospects good for fatherhood after testicular cancer

Infertility is common in men treated for testicular cancer but new research shows a large number of them may regain their ability to father children.

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NEW YORK (Reuters Health) - Infertility is common in men treated for testicular cancer but new research shows a large number of them may regain their ability to father children. A study of Norwegian men treated with surgery and chemotherapy for cancer limited to one testicle found that 80 percent of those who tried, succeeded in fathering a child after therapy. The study by Dr. Marianne Brydoy of Haukeland University Hospital in Bergen, Norway and colleagues is the first to measure fertility success in men who underwent two to four cycles of cisplatin-based chemotherapy following surgery. Previous research examined and compared older treatment methods, less commonly used today. The results, showing that many men can father children after testicular cancer treatment, were not a big surprise, Brydoy told Reuters Health, given recent advances in treatments for testicular cancer. However, it's the first time paternity success rates were associated with the number of chemotherapy cycles, Brydoy noted. "We were able to show that there likely is a difference with number of cycles. However, larger studies are needed to confirm our results," Brydoy saidAn estimated 8,400 U.S. men are diagnosed with testicular cancer each year. For the most part, it's a young man's disease usually striking between the ages of 20 and 39 when interest in starting a family is the high. Testicular cancer is considered one of the most treatable cancers because it usually responds well to chemotherapy. Cure rates are high even when it has spread to distant parts of the body but survivors can be left struggling with fertility issues including low sperm counts. As a result, patients are often encouraged to bank their sperm before surgery and standard chemotherapy treatment.The Norwegian researchers now report that after 12 years of follow-up, 85 of the 106 men in the study who attempted to father a child after treatment were successful -- a success rate of 80 percent. "Some of them, however, had some assistance with reproduction, but none used semen that was cryopreserved [frozen] prior to chemotherapy," Brydoy said.The men in the study were drawn from a pool of 1462 Norwegians diagnosed and treated for testicular cancer between 1998 and 2002. They filled out detailed questionnaires and their medical records were consulted to verify the diagnosis and treatment received. From the original pool, 106 men met the criteria for paternity analysis. Their paternity rates were compared against 46 testicular cancer patients who had surgery but no chemotherapy. Success in fathering a child after treatment was closely associated with how many chemotherapy cycles a man was given. As the number of chemo cycles increased, the paternity success rate dropped; all eight men given two cycles of cisplatin-based chemo reported success; of the 30 who got three cycles, 25 (83 percent) reported success, and 52 (76 percent) of the 68 who got four cycles were successful. Whether the declining success rate with increasing chemo cycles is the result of the toxic therapy alone or the result of the chemotherapy and extent of disease is not answered by this study. Men with more advanced testicular cancer are more likely to receive 3 or 4 cycles of chemotherapy. Despite the successes, the investigators say that sperm banking should still be an option for all men with testicular cancer. The ability to produce sperm may still be "marginal" in some, they note, and "we cannot guarantee sperm quality" if the disease returns. Parenthood is important to cancer survivors, Andrea Salonia of Italy's Scientific Institute H. San Raffaele, wrote in an accompanying editorial. A comprehensive discussion of risks to fertility and options should be a "cornerstone step" of treatment, she argued, and fertility-preserving procedures should be offered to men dealing with any cancer well in advance of fertility damaging treatments.


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