Does One Course of Chemotherapy Affect Sperm Count?

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Highlights:

• A single round of radiation or chemotherapy in early testicular cancer is safe and has minimal effect on sperm counts
• Standard treatment of testicular cancer is surgical removal of cancer followed by radiation or chemotherapy and carries the potential risk of infertility due to drastic fall in sperm counts
• Testicular cancer is the most common cancer in men between the ages of 15 - 40 years and the average age at diagnosis is 33 years
• This study reassures young men who are concerned about the risk of infertility due to their treatment that may affect their hopes of becoming fathers in the future

A single course of radiation or chemotherapy for early-stage 1 testicular cancer is safe and will not affect sperm counts, according to a first of its kind study undertaken at the Karolinska University Hospital in Stockholm, Sweden.

The study was led by Dr Kristina Weibring and the findings of the study appear in the leading cancer journal Annals of Oncology.

‘One course of chemotherapy or radiation for early-stage testis cancer has a minimal long term impact on sperm counts. These findings reassure young men hoping to become fathers in the future and might be afraid of the potential risk of treatment in causing infertility.’

Effects of Multiple Rounds of Chemotherapy & Radiation in Testicular Cancer

Several studies have found that multiple courses of chemotherapy or high doses of radiotherapy given to men having advanced stage testicular cancer can markedly decrease reduce sperm count and concentrations, potentially causing infertility. However, it remains unclear whether a single round of chemotherapy or radiotherapy in early-stage testicular cancer will affect sperm counts similarly or not.

The aim of the study hoped to determine the effects of a single course of chemotherapy/radiation on sperm counts and patient's fertility in early stage testicular cancer.

Dr Kristina Weibring, a cancer doctor at the Karolinska University Hospital in Stockholm, Sweden, said: "We wanted to examine in more detail if postoperative treatment, given to decrease the risk of recurrence after the removal of the tumorous testicle, would affect the sperm count and sperm concentration long term in testicular cancer patients with no spread of the disease. This is important to find out, since treatment with one course of postoperative chemotherapy has been shown to decrease the risk of relapse substantially, thereby reducing the number of patients having to be treated with several courses of chemotherapy."

Effects of Single Course of Chemotherapy in Sperm Counts of Testis Cancer Patients

• The study enlisted 182 men aged between 18 and 50 years diagnosed with stage I testicular cancer and treated with surgical removal of the affected testis (orchiectomy) within the past five years
• The duration of the study was from 2001-2006 and the patients were treated either at Lund or Stockholm
• Following surgery, they received radiation (14 fractions of 1.8 Gy each, up to a total dose of 25 Gy) or one course of chemotherapy, or were just under close surveillance, 1.e. there was no postoperative treatment
• All patients provided semen samples after orchiectomy before undergoing postoperative chemotherapy or radiation, and subsequently six months, one year, two years, three years and five years thereafter
• From 2006 radiotherapy was ceased as standard treatment in Sweden due to the potential risk of causing secondary cancer

The key findings of the study were as follows:

• In men who received radiotherapy, there was a significant reduction in average sperm counts six months after treatment, but not in men who received chemotherapy
• However, sperm counts started to rise in the radiation group following six months, and continued to increase in all groups for nearly 5 years following completion of treatment

The findings of the study thus indicate that a single round of radiation or chemotherapy following orchiectomy has an only minimal longterm impact on sperm counts with low risk of infertility.

Dr Weibring said, "I am very excited to see these results as I wasn't expecting sperm to recover so well after postoperative treatment. I didn't expect as negative an effect as if the patient had received many courses of chemotherapy, since it is much more toxic, but I was not sure how much the sperm would be affected by one course".

Takeaways from This Study and Future Plans

• Findings of the study will help doctors to provide evidence-based information to patients which would be reassuring to young men who hope to father sometime in the future, but more studies are needed to validate these findings before routine use in the clinical setting
• Nevertheless, the authors still recommend procedures such as sperm banking and the possible necessity of assisted reproductive technologies as many of these men have low sperm counts even at the time of diagnosis of cancer
• The next step will be to further studies to determine the adverse effects on sperm counts of various chemotherapy regimens.

Summary

A single cycle of radiation or chemotherapy for men with early-stage testicular cancer is safe and does not affect sperm counts and the findings should be reassuring to several young patients worldwide.

Reference:

1. Sperm count in Swedish clinical stage I testicular cancer patients following adjuvant treatment - (https:doi.org/10.1093/annonc/mdz017)

Source: Medindia

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