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. 1999 May;80(5-6):801–807. doi: 10.1038/sj.bjc.6690424

Long-term effects on sexual function and fertility after treatment of testicular cancer

J T Hartmann 1, C Albrecht 1, H-J Schmoll 2, M A Kuczyk 3, C Kollmannsberger 1, C Bokemeyer 1
PMCID: PMC2362282  PMID: 10360658

Abstract

This retrospective study evaluates the types and incidences of sexual disturbances and fertility distress in patients cured from testicular cancer and examines whether there is an effect resulting from different treatment modalities. A self-reported questionnaire was sent to 124 randomly selected patients who were treated at Hanover University Medical School between 1970 and 1993. Ninety-eight patients were included in the study, representing a response rate of 78%. All patients had been in complete remission (CR) for at least 24 months. The median age at diagnosis was 28 years (range 17–44). The median follow-up at the time of study was 12.0 years (range 2.8–25.6). Twenty patients (20%) had been treated for seminomatous and 78 patients (80%) for non-seminomatous germ cell tumours. Treatment included surveillance (7%), primary retroperitoneal lymph node dissection (RPLND) (13%), chemotherapy (CT) (33%), CT + secondary resection of residual retroperitoneal tumour mass (SRRTM) (43%) and infradiaphragmatic radiotherapy (4%). Patients receiving two treatment modalities (CT+SRRTM) reported more frequent an unfulfilled wish for children. Inability of ejaculation was clearly associated with RPLND and SRRTM. Subjective aspects of sexuality, like loss of sexual drive and reduced erectile potential, occurred only in a minority of patients after treatment. No abnormalities were observed concerning the course of pregnancies of partners. In conclusion, sexual dysfunction and infertility are common long-lasting sequelae in testicular cancer survivors affecting approximately 20% of patients. The relative risk for infertility appeared to be elevated for patients treated with the combination of CT+SRRTM. Twenty-one of 40 patients were able to fulfil their wish for children, and no congenital abnormalities were observed in these children. © 1999 Cancer Research Campaign

Keywords: testicular cancer, sexual functioning, fertility aspects, chemotherapy, RPLND, irradiation

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Footnotes

This work represents part of the thesis of Ch. Albrecht at Hanover University Medical School.This paper was presented in part at the 9th European Cancer Conference on Clinical Oncology (ECCO 9), Hamburg, 14–18 September 1997

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aass N., Fosså S. D., Theodorsen L., Norman N. Prediction of long-term gonadal toxicity after standard treatment for testicular cancer. Eur J Cancer. 1991;27(9):1087–1091. doi: 10.1016/0277-5379(91)90298-r. [DOI] [PubMed] [Google Scholar]
  2. Arai Y., Kawakita M., Okada Y., Yoshida O. Sexuality and fertility in long-term survivors of testicular cancer. J Clin Oncol. 1997 Apr;15(4):1444–1448. doi: 10.1200/JCO.1997.15.4.1444. [DOI] [PubMed] [Google Scholar]
  3. Berthelsen J. G. Sperm counts and serum follicle-stimulating hormone levels before and after radiotherapy and chemotherapy in men with testicular germ cell cancer. Fertil Steril. 1984 Feb;41(2):281–286. doi: 10.1016/s0015-0282(16)47605-3. [DOI] [PubMed] [Google Scholar]
  4. Bloom J. R., Fobair P., Gritz E., Wellisch D., Spiegel D., Varghese A., Hoppe R. Psychosocial outcomes of cancer: a comparative analysis of Hodgkin's disease and testicular cancer. J Clin Oncol. 1993 May;11(5):979–988. doi: 10.1200/JCO.1993.11.5.979. [DOI] [PubMed] [Google Scholar]
  5. Bokemeyer C. Current trends in chemotherapy for metastatic nonseminomatous testicular germ cell tumors. Oncology. 1998 May-Jun;55(3):177–188. doi: 10.1159/000011854. [DOI] [PubMed] [Google Scholar]
  6. Bokemeyer C., Köhrmann O., Tischler J., Weissbach L., Räth U., Haupt A., Schöffski P., Harstrick A., Schmoll H. J. A randomized trial of cisplatin, etoposide and bleomycin (PEB) versus carboplatin, etoposide and bleomycin (CEB) for patients with 'good-risk' metastatic non-seminomatous germ cell tumors. Ann Oncol. 1996 Dec;7(10):1015–1021. doi: 10.1093/oxfordjournals.annonc.a010493. [DOI] [PubMed] [Google Scholar]
  7. Brenner J., Vugrin D., Whitmore W. F., Jr Effect of treatment on fertility and sexual function in males with metastatic nonseminomatous germ cell tumors of testis. Am J Clin Oncol. 1985 Apr;8(2):178–182. doi: 10.1097/00000421-198504000-00014. [DOI] [PubMed] [Google Scholar]
  8. Bruckert E. How frequent is unintentional childlessness in Germany? Andrologia. 1991 May-Jun;23(3):245–250. doi: 10.1111/j.1439-0272.1991.tb02550.x. [DOI] [PubMed] [Google Scholar]
  9. Buena F., Swerdloff R. S., Steiner B. S., Lutchmansingh P., Peterson M. A., Pandian M. R., Galmarini M., Bhasin S. Sexual function does not change when serum testosterone levels are pharmacologically varied within the normal male range. Fertil Steril. 1993 May;59(5):1118–1123. [PubMed] [Google Scholar]
  10. Burns L. H. Infertility as boundary ambiguity: one theoretical perspective. Fam Process. 1987 Sep;26(3):359–372. doi: 10.1111/j.1545-5300.1987.00359.x. [DOI] [PubMed] [Google Scholar]
  11. Cassileth B. R., Steinfeld A. D. Psychological preparation of the patient and family. Cancer. 1987 Aug 1;60(3 Suppl):547–552. doi: 10.1002/1097-0142(19870801)60:3+<547::aid-cncr2820601518>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  12. Cavalli F., Monfardini S., Pizzocaro G. Report on the International Workshop on Staging and Treatment of Testicular Cancer. Eur J Cancer. 1980 Oct;16(10):1367–1372. doi: 10.1016/0014-2964(80)90296-0. [DOI] [PubMed] [Google Scholar]
  13. Dodds L., Marrett L. D., Tomkins D. J., Green B., Sherman G. Case-control study of congenital anomalies in children of cancer patients. BMJ. 1993 Jul 17;307(6897):164–168. doi: 10.1136/bmj.307.6897.164. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Drasga R. E., Einhorn L. H., Williams S. D., Patel D. N., Stevens E. E. Fertility after chemotherapy for testicular cancer. J Clin Oncol. 1983 Mar;1(3):179–183. doi: 10.1200/JCO.1983.1.3.179. [DOI] [PubMed] [Google Scholar]
  15. Einhorn L. H. Treatment of testicular cancer: a new and improved model. J Clin Oncol. 1990 Nov;8(11):1777–1781. doi: 10.1200/JCO.1990.8.11.1777. [DOI] [PubMed] [Google Scholar]
  16. Fosså S. D., Aass N., Kaalhus O. Testicular cancer in young Norwegians. J Surg Oncol. 1988 Sep;39(1):43–63. doi: 10.1002/jso.2930390110. [DOI] [PubMed] [Google Scholar]
  17. Fosså S. D., Abyholm T., Normann N., Jetne V. Post-treatment fertility in patients with testicular cancer. III. Influence of radiotherapy in seminoma patients. Br J Urol. 1986 Jun;58(3):315–319. doi: 10.1111/j.1464-410x.1986.tb09062.x. [DOI] [PubMed] [Google Scholar]
  18. Fosså S. D., Klepp O., Aakvaag A. Serum hormone levels in patients with malignant testicular germ cell tumours without clinical and/or radiological signs of tumour. Br J Urol. 1980 Apr;52(2):151–157. doi: 10.1111/j.1464-410x.1980.tb02946.x. [DOI] [PubMed] [Google Scholar]
  19. Fosså S. D., Ous S., Abyholm T., Norman N., Loeb M. Post-treatment fertility in patients with testicular cancer. II. Influence of cis-platin-based combination chemotherapy and of retroperitoneal surgery on hormone and sperm cell production. Br J Urol. 1985 Apr;57(2):210–214. doi: 10.1111/j.1464-410x.1985.tb06426.x. [DOI] [PubMed] [Google Scholar]
  20. Goldstein I., Feldman M. I., Deckers P. J., Babayan R. K., Krane R. J. Radiation-associated impotence. A clinical study of its mechanism. JAMA. 1984 Feb 17;251(7):903–910. doi: 10.1001/jama.251.7.903. [DOI] [PubMed] [Google Scholar]
  21. Gritz E. R., Wellisch D. K., Wang H. J., Siau J., Landsverk J. A., Cosgrove M. D. Long-term effects of testicular cancer on sexual functioning in married couples. Cancer. 1989 Oct 1;64(7):1560–1567. doi: 10.1002/1097-0142(19891001)64:7<1560::aid-cncr2820640735>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  22. Guazzieri S., Lembo A., Ferro G., Artibani W., Merlo F., Zanchetta R., Pagano F. Sperm antibodies and infertility in patients with testicular cancer. Urology. 1985 Aug;26(2):139–142. doi: 10.1016/0090-4295(85)90046-9. [DOI] [PubMed] [Google Scholar]
  23. Harstrick A., Schmoll H. J., Köhne-Wömpner C. H., Bergmann L., Lammers U., Hohnloser J., Dölken G., Reichhardt P., Siegert W., Natt F. Cisplatin, etoposide, ifosfamide, vincristine and bleomycin combination chemotherapy for far advanced testicular carcinoma. Ann Oncol. 1991 Mar;2(3):197–202. doi: 10.1093/oxfordjournals.annonc.a057904. [DOI] [PubMed] [Google Scholar]
  24. Hartmann J. T., Candelaria M., Kuczyk M. A., Schmoll H. J., Bokemeyer C. Comparison of histological results from the resection of residual masses at different sites after chemotherapy for metastatic non-seminomatous germ cell tumours. Eur J Cancer. 1997 May;33(6):843–847. doi: 10.1016/s0959-8049(96)00517-5. [DOI] [PubMed] [Google Scholar]
  25. Hartmann J. T., Schmoll H. J., Kuczyk M. A., Candelaria M., Bokemeyer C. Postchemotherapy resections of residual masses from metastatic non-seminomatous testicular germ cell tumors. Ann Oncol. 1997 Jun;8(6):531–538. doi: 10.1023/a:1008200425854. [DOI] [PubMed] [Google Scholar]
  26. Hendry W. F., Stedronska J., Jones C. R., Blackmore C. A., Barrett A., Peckham M. J. Semen analysis in testicular cancer and Hodgkin's disease: pre- and post-treatment findings and implications for cryopreservation. Br J Urol. 1983 Dec;55(6):769–773. doi: 10.1111/j.1464-410x.1983.tb03423.x. [DOI] [PubMed] [Google Scholar]
  27. Jones D. R., Norman A. R., Horwich A., Hendry W. F. Ejaculatory dysfunction after retroperitoneal lymphadenectomy. Eur Urol. 1993;23(1):169–171. doi: 10.1159/000474588. [DOI] [PubMed] [Google Scholar]
  28. Jonker-Pool G., van Basten J. P., Hoekstra H. J., van Driel M. F., Sleijfer D. T., Koops H. S., van de Wiel H. B. Sexual functioning after treatment for testicular cancer: comparison of treatment modalities. Cancer. 1997 Aug 1;80(3):454–464. doi: 10.1002/(sici)1097-0142(19970801)80:3<454::aid-cncr13>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  29. Lampe H., Horwich A., Norman A., Nicholls J., Dearnaley D. P. Fertility after chemotherapy for testicular germ cell cancers. J Clin Oncol. 1997 Jan;15(1):239–245. doi: 10.1200/JCO.1997.15.1.239. [DOI] [PubMed] [Google Scholar]
  30. Loehrer P. J., Sr, Lauer R., Roth B. J., Williams S. D., Kalasinski L. A., Einhorn L. H. Salvage therapy in recurrent germ cell cancer: ifosfamide and cisplatin plus either vinblastine or etoposide. Ann Intern Med. 1988 Oct 1;109(7):540–546. doi: 10.7326/0003-4819-109-7-540. [DOI] [PubMed] [Google Scholar]
  31. Moynihan C. Testicular cancer: the psychosocial problems of patients and their relatives. Cancer Surv. 1987;6(3):477–510. [PubMed] [Google Scholar]
  32. Nijman J. M., Schraffordt Koops H., Kremer J., Sleijfer D. T. Gonadal function after surgery and chemotherapy in men with stage II and III nonseminomatous testicular tumors. J Clin Oncol. 1987 Apr;5(4):651–656. doi: 10.1200/JCO.1987.5.4.651. [DOI] [PubMed] [Google Scholar]
  33. Petersen P. M., Hansen S. W., Giwercman A., Rørth M., Skakkebaek N. E. Dose-dependent impairment of testicular function in patients treated with cisplatin-based chemotherapy for germ cell cancer. Ann Oncol. 1994 Apr;5(4):355–358. doi: 10.1093/oxfordjournals.annonc.a058840. [DOI] [PubMed] [Google Scholar]
  34. Rieker P. P., Edbril S. D., Garnick M. B. Curative testis cancer therapy: psychosocial sequelae. J Clin Oncol. 1985 Aug;3(8):1117–1126. doi: 10.1200/JCO.1985.3.8.1117. [DOI] [PubMed] [Google Scholar]
  35. Rieker P. P., Fitzgerald E. M., Kalish L. A. Adaptive behavioral responses to potential infertility among survivors of testis cancer. J Clin Oncol. 1990 Feb;8(2):347–355. doi: 10.1200/JCO.1990.8.2.347. [DOI] [PubMed] [Google Scholar]
  36. Rieker P. P., Fitzgerald E. M., Kalish L. A., Richie J. P., Lederman G. S., Edbril S. D., Garnick M. B. Psychosocial factors, curative therapies, and behavioral outcomes. A comparison of testis cancer survivors and a control group of healthy men. Cancer. 1989 Dec 1;64(11):2399–2407. doi: 10.1002/1097-0142(19891201)64:11<2399::aid-cncr2820641134>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  37. Sankila R., Olsen J. H., Anderson H., Garwicz S., Glattre E., Hertz H., Langmark F., Lanning M., Møller T., Tulinius H. Risk of cancer among offspring of childhood-cancer survivors. Association of the Nordic Cancer Registries and the Nordic Society of Paediatric Haematology and Oncology. N Engl J Med. 1998 May 7;338(19):1339–1344. doi: 10.1056/NEJM199805073381902. [DOI] [PubMed] [Google Scholar]
  38. Schmoll H. J., Harstrick A., Bokemeyer C., Dieckmann K. P., Clemm C., Berdel W. E., Souchon R., Schöber C., Wilke H., Poliwoda H. Single-agent carboplatinum for advanced seminoma. A phase II study. Cancer. 1993 Jul 1;72(1):237–243. doi: 10.1002/1097-0142(19930701)72:1<237::aid-cncr2820720142>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  39. Schover L. R., Gonzales M., von Eschenbach A. C. Sexual and marital relationships after radiotherapy for seminoma. Urology. 1986 Feb;27(2):117–123. doi: 10.1016/0090-4295(86)90367-5. [DOI] [PubMed] [Google Scholar]
  40. Schover L. R. Sexuality and fertility in urologic cancer patients. Cancer. 1987 Aug 1;60(3 Suppl):553–558. doi: 10.1002/1097-0142(19870801)60:3+<553::aid-cncr2820601519>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  41. Schover L. R., von Eschenbach A. C. Sexual and marital relationships after treatment for nonseminomatous testicular cancer. Urology. 1985 Mar;25(3):251–255. doi: 10.1016/0090-4295(85)90322-x. [DOI] [PubMed] [Google Scholar]
  42. Senturia Y. D., Peckham C. S. Children fathered by men treated with chemotherapy for testicular cancer. Eur J Cancer. 1990 Apr;26(4):429–432. doi: 10.1016/0277-5379(90)90010-q. [DOI] [PubMed] [Google Scholar]
  43. Sleijfer S., van der Mark T. W., Schraffordt Koops H., Mulder N. H. Decrease in pulmonary function during bleomycin-containing combination chemotherapy for testicular cancer: not only a bleomycin effect. Br J Cancer. 1995 Jan;71(1):120–123. doi: 10.1038/bjc.1995.24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Stoter G., Koopman A., Vendrik C. P., Struyvenberg A., Sleyfer D. T., Willemse P. H., Schraffordt Koops H., van Oosterom A. T., ten Bokkel Huinink W. W., Pinedo H. M. Ten-year survival and late sequelae in testicular cancer patients treated with cisplatin, vinblastine, and bleomycin. J Clin Oncol. 1989 Aug;7(8):1099–1104. doi: 10.1200/JCO.1989.7.8.1099. [DOI] [PubMed] [Google Scholar]
  45. Tinkler S. D., Howard G. C., Kerr G. R. Sexual morbidity following radiotherapy for germ cell tumours of the testis. Radiother Oncol. 1992 Nov;25(3):207–212. doi: 10.1016/0167-8140(92)90270-5. [DOI] [PubMed] [Google Scholar]
  46. Tomić R., Bergman B., Damber J. E., Littbrand B., Löfroth P. O. Effects of external radiation therapy for cancer of the prostate on the serum concentrations of testosterone, follicle-stimulating hormone, luteinizing hormone and prolactin. J Urol. 1983 Aug;130(2):287–289. doi: 10.1016/s0022-5347(17)51110-6. [DOI] [PubMed] [Google Scholar]
  47. Williams S. D., Birch R., Einhorn L. H., Irwin L., Greco F. A., Loehrer P. J. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med. 1987 Jun 4;316(23):1435–1440. doi: 10.1056/NEJM198706043162302. [DOI] [PubMed] [Google Scholar]
  48. el-Beheiry A., Souka A., el-Kamshoushi A., Hussein S., el-Sabah K. Hyperprolactinemia and impotence. Arch Androl. 1988;21(3):211–214. doi: 10.3109/01485018808986743. [DOI] [PubMed] [Google Scholar]
  49. van Basten J. P., Hoekstra H. J., van Driel M. F., Koops H. S., Droste J. H., Jonker-Pool G., van de Wiel H. B., Sleijfer D. T. Sexual dysfunction in nonseminoma testicular cancer patients is related to chemotherapy-induced angiopathy. J Clin Oncol. 1997 Jun;15(6):2442–2448. doi: 10.1200/JCO.1997.15.6.2442. [DOI] [PubMed] [Google Scholar]
  50. van Basten J. P., Jonker-Pool G., van Driel M. F., Sleijfer D. T., Droste J. H., van de Wiel H. B., Schraffordt Koops H., Molenaar W. M., Hoekstra H. J. Sexual functioning after multimodality treatment for disseminated nonseminomatous testicular germ cell tumor. J Urol. 1997 Oct;158(4):1411–1416. doi: 10.1097/00005392-199710000-00024. [DOI] [PubMed] [Google Scholar]
  51. van Basten J. P., Jonker-Pool G., van Driel M. F., Sleijfer D. T., van der Wiel H. B., Hoekstra H. J. The sexual sequelae of testicular cancer. Cancer Treat Rev. 1995 Sep;21(5):479–495. doi: 10.1016/0305-7372(95)90031-4. [DOI] [PubMed] [Google Scholar]

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