Sperm quality unaffected by one course of radiation therapy or chemotherapy for early testicular cancer


Men with early stage testicular cancer can safely receive one course of chemotherapy or radiotherapy after surgery without it having a long-term effect on their sperm count, according to a study published in the leading cancer journal Annals of Oncology [1] on February 25.

Although it is known already that several rounds of chemotherapy or high doses of radiotherapy given to men with more advanced testicular cancer can reduce sperm count and concentration, it has been unclear whether a single cycle of chemotherapy or radiotherapy would have a similar effect in men with stage I disease.

Dr, Kristina Weibring, a cancer doctor at the  Hospital in Stockholm, Sweden, who led the study, 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. To our knowledge, no such study has been done before.

“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.”

Testicular cancer is the most common cancer in young men between the ages of 15 and 40. When it is diagnosed, all patients have the testicle containing the tumour removed, a surgical procedure called orchiectomy.

In this study, 182 men aged between 18 and 50, diagnosed with stage I testicular cancer and who had had an orchiectomy within the past five years, took part in the study between 2001 and 2006. They were treated either in Stockholm or Lund. After surgery, they received radiotherapy (14 fractions of 1.8 Gy each, up to a total dose of 25 Gy) or one course of chemotherapy, or were managed by surveillance, meaning there was no postoperative treatment. They provided semen samples after orchiectomy but before further treatment, and then six months, one year, two years, three years and five years thereafter. From 2006 onward, radiotherapy was no longer used as a standard treatment in Sweden because of the risk of causing secondary cancer.

“We found no clinically significant detrimental long-term effect in either total sperm number or sperm concentration, irrespective of the type of postoperative treatment received,” said Dr Weibring. “Among men who received radiotherapy, there was a distinct decrease in average sperm number and concentration six months after treatment, though not in those who received chemotherapy. However, sperm number and concentration recovered in the radiotherapy group after six months, and continued to increase in all groups up to five years after treatment.

“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.

“With the results of this study we can give the patients more adequate information on potential side effects from postoperative treatment. Testicular cancer patients are often young men wanting to father children at some point, and we find, in many cases, that the patients are afraid of the potential risk of infertility caused by chemotherapeutic treatment. These findings should provide some reassurance to them.”

A well-known problem for men diagnosed with testicular cancer is an impaired ability to create sperm. A condition called testicular dysgenesis syndrome, characterized by poor semen quality among other things, may play a role in this and is also associated with a higher risk of developing testicular cancer. In addition, the orchiectomy and the cancer itself may also affect sperm quality. The removal of one testicle does not necessarily affect a man’s sperm count and concentration as the remaining testicle can compensate.

Dr Weibring concluded: “Our results are promising but more studies are needed, and we still recommend sperm banking before orchiectomy as a number of patients may have low sperm counts at the time of diagnosis that persists after postoperative treatment. In addition, the type of testicular cancer and whether or not it will need further treatments are unknown factors before the orchiectomy. Assisted reproductive measures may be necessary for these patients regardless of any treatment given.”

Editor-in-chief of Annals of Oncology, Professor Fabrice André, Professor in the Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France, commented: “This study, together with other research efforts, explores the paths to recovering a normal life after cancer. The finding that one course of chemotherapy has minimal impact on sperm count offers hope for thousands of patients worldwide, but we all must keep in mind that these data are preliminary and will require validation before we can use them in clinics. The next step will be to establish how to predict the toxic effects on sperm count of different chemotherapy regimens.”

REFERENCE

[1] “Sperm count in Swedish clinical stage I testicular cancer patients following adjuvant treatment”, by Kristina Weibring et al. Annals of Oncology. doi:10.1093/annonc/mdz017

The research was supported by grants from the Swedish Government Funding for Clinical Research, the Swedish Cancer Society, Gunnar Nilsson’s Cancer Fund, Malmo University Hospital Foundation for Cancer Research and Foundation for Urological Research, and King Gustaf V’s Jubilee Fund for Cancer Research.

Advertisements

Scientific Review Suggests Aspirin Significantly Cuts Cancer Rates


A recent review of several studies confirms that taking a small daily dose of aspirin significantly reduces the risk of developing – or dying from several kinds of cancer.

Several clinical studies have suggested that aspirin can reduce the risk of colon, and other cancer’s of the gastrointestinal tract. (2,3,4) In order to study this further, researchers analyzed all the available evidence from studies and clinical trials evaluating taking aspirin daily for 10 years and confirmed that daily aspirin could reduce bowel cancer cases by around 35 percent and deaths from the disease by 40 percent.  These results were published in the Annals of Oncology journal.(1)

Aspirin, originally developed by the German drug maker Bayer, is a cheap, over-the-counter drug generally used to combat pain or reduce fever.  The drug when taking in smaller doses of 75-100 milligrams per day reduces the risk of clots forming in blood vessels and can therefore protect against heart attacks and strokes, so it is often prescribed for people who already suffer with heart disease and have already had one or several attacks.
The authors found that in addition to reducing the risk of developing colon cancer, the risk of esophageal and stomach cancer were cut by 30 percent and deaths from these cancers reduced by 35 to 50 percent.

The authors of the current study observed that if everyone between 50 and 65 years of age started taking aspirin daily for at least 10 years, there would be a 9 percent reduction in the number of cancers, strokes and heart attacks overall in men, and around 7 percent in women.

There are however some serious side effects of aspirin including a risk of bleeding in the stomach.  Among 60-year-olds who take daily aspirin for 10 years, the risk of digestive tract bleeding increases from 2.2 percent to 3.6 percent, and this could be life-threatening in a small proportion of people. The risk of bleeding has prevented some doctors from advising patients to take aspirin as regularly as every day. This risk of bleeding is well known and should not be ignored especially in individuals at high risk.  In this era of wellness however where many individuals look to alternative medicines, nutritional supplements and foods rich in anti-oxidants, and other nutrients to reduce their caner risk an aspirin a day may be the simplest and most cost effective way to reduce the risk of gastrointestinal cancers.

References:
1.    Cuzick J, Thorat MA, Bosetti C. et al. Estimates of benefits and harms of prophylactic use of aspirin in the general population. Annals of Oncology. 10,2014 doi:10.1093/annonc/md
2.    Burn J, Bishop T, Mecklin JP, et al. Effect of aspirin or resistant starch on colorectal neoplasia in the lynch syndrome. New England Journal of Medicine. 2008; 359: 2567-2578.
3.    Burn J, Gerdes A-M, Macrae F et al. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial. Lancet. Early online publication October 28, 2011.
4.    Tan X-L, Reid Lombardo KM, Bamlet WR, Robinson DP, Anderson K, Petersen GM. Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen and risk of pancreatic cancer. Presented at the 102nd Annual Meeting of the American Association for Cancer Research (AACR), April 2-6, 2011, Orlando, FL. Abstract 1902.