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.

6 Myths about Testicular Cancer.


April is Testicular Cancer Awareness Month, and though the disease gets a lot of attention, there are many misconceptions surrounding it. Memorial Sloan Kettering medical oncologists George Bosl and Darren Feldman and social worker David Sarfati separate fact from fiction.

Man examining himself.

Highlights
  • Testicular cancer is a rare but highly curable disease.
  • Testicular cancer strikes younger men.
  • Injuring your testicles won’t cause testicular cancer.
  • Many testicular cancer patients have healthy, normal sex lives after treatment.
  • Testicular cancer usually doesn’t affect fertility.
  • Support services can help with emotional side effects.

With advocacy groups such as the Movember Foundation spreading the word about testicular cancer, men have become much more comfortable talking about what can be a delicate topic. In honor of Testicular Cancer Awareness Month, Memorial Sloan Kettering medical oncologists George Bosl and Darren Feldman and social worker David Sarfati break down some of the myths about a cancer that kills hundreds of men every year.

Myth #1: Testicular cancer is common.

Despite testicular cancer’s high profile, it makes up just 1% of all men’s cancers, says Dr. Feldman, an expert in the disease. It affects one in every 263 men over their lifetime, whereas prostate cancer affects one in every seven men.

Myth #2: Older men are at highest risk for testicular cancer.

Most cancers tend to primarily affect older patients, but testicular cancer is different: It mainly strikes men in their teens, 20s, and 30s. So while it is unusual among all men, “it is the most common cancer in men between the ages of 15 and 40,” Dr. Feldman says.

No matter how extensive the disease at diagnosis, the possibility of cure exists.

Myth #3: Injuring your testicles increases your risk.

“There’s no evidence that trauma leads to testicular cancer,” Dr. Feldman says. Neither do topical creams, horseback riding, or bike riding, for that matter. “I’ve heard everything from getting hit by tennis balls to having a cell phone in your pocket, and all of that is false,” says Dr. Bosl. Indeed, the main risk factors are a family history and being born with something called an undescended testicle, in which the testicle gets stuck in the abdomen instead of descending into the scrotum before birth.

Myth #4: Testicular cancer is hard to treat.

Testicular cancer is the single most curable solid cancer, with a cure rate of more than 95%, says Dr. Feldman. It’s frequently caught early, but even if discovered at a later stage, this type of cancer is highly curable. “No matter how extensive the disease at diagnosis, the possibility of cure exists,” Dr. Bosl says.

Myth #5: Your sex life will suffer if you get testicular cancer.

Most patients can enjoy sex and orgasm just as they did before treatment, assure Drs. Feldman and Bosl. That’s because only the affected testicle is removed during treatment, and the other testicle makes enough testosterone to maintain sex drive and normal erections. Even if there is cancer in both testicles and they both have to be removed, testosterone replacement can get men feeling back to normal.

What’s more, there’s no shame in talking about it. Having concerns about sexual side effects is completely understandable. “A lot of people think, Am I the only person who’s thinking that?” says Mr. Sarfati, who regularly sees testicular patients. “We validate what they’re saying and normalize that this is completely appropriate.”

Myth #6: You can’t have children after treatment.

Testicular Cancer Diagnosis

Because sperm is made in the testicles, many men of childbearing age may worry that testicular cancer will impact their fertility. But that’s not true for the vast majority of men. “You can have normal fertilitywith one testicle,” Dr. Feldman says. A patient’s sperm count usually returns to its baseline normal post-treatment, adds Dr. Bosl. While there is a 20 to 30% risk of infertility in men who receivechemotherapy, they can bank their sperm before starting, which gives them the opportunity to have children after treatment even if they become infertile.

Creatine Linked to Testicular Cancer


Men who use muscle-building supplements containing creatine or androstenedione may have a higher risk of getting testicular cancer, according to a study published online in the British Journal of Cancer.

This risk seems to rise even more among men who begin using the supplements before age 25, who use various kinds of them to build muscle, or who use them for a long time.

Young people in particular use these products, and the number of users is growing, according to researcher Tongzhang Zheng, who led the study at Yale University.

While it’s unclear how many young people use them, “we do know that the [muscle-building supplement] business rakes in billions of dollars,” Zheng says.

The new study included 356 men diagnosed with testicular cancer between 2006 and 2010, and 513 men without testicular cancer. Participants were between the ages of 18 and 55 and lived in Connecticut or Massachusetts.
The men were asked whether they had risk factors for testicular cancer, like smoking, drinking, exercise, a family history of the disease, undescended testicles, and past injuries to the testicles or groin. The interviewers also asked about their lifetime supplement use, including use of 30 different types of muscle-building supplement powders or pills. The researchers used product labels to look into the major ingredients, including creatine, protein, and androstenedione.

The interviews revealed that almost 20% of participants with testicular cancer had used muscle-building supplements. The higher odds of getting the disease remained after the researchers took other things into account.

Testicular cancer is a common cancer in men ages 15 to 39. And rates of it have been on the rise in recent decades.

The reasons for the increase aren’t clear, Zheng says. It’s also unknown what ingredients in muscle-building supplements might be responsible, but scientists do know some of the ingredients can damage the testicles, he says.

Natural components in muscle-building supplements could act like artificial hormones, Zheng and colleagues say. Some products could also have impurities or less-active ingredients than those listed on the product label. Still others may have “hidden” ingredients not listed on the label, such as androgenic steroids, which have been linked to testicular cancer in rats.

Recently, the FDA raised concerns about muscle-building supplements. On April 13, the agency warned consumers not to use a supplement called Tri-Methyl Xtreme, because it might contain anabolic steroids that can cause liver damage.

Scientists find link between muscle-building supplements and testicular cancer


Men who take body-building supplements such as creatine or androstenedione have up to a 177 percent higher chance of developing testicular cancer than men who don’t, new research suggests. And the risk is worse if you started using young.

It’s very preliminary work, but the results could help to explain why testicular cancer has become far more common (more than 1.5 times more common, to be precise) than it was in the ‘70s, along with society’s growing consumption of supplements.

“The observed relationship was strong,” said epidemiologist and study-leader Tongzhang Zheng, from Brown University in the US, in a press release. “If you used at earlier age, you had a higher risk. If you used them longer, you had a higher risk. If you used multiple types, you had a higher risk.”

This is the first study to link testicular cancer to body-building supplements, but it was inspired by earlier research that suggested body-building supplements, namely androstenedione, could damage the testes.

To work out what was going on, the team conducted detailed lifestyle interviews with nearly 900 men in the US – 356 of them had been diagnosed with testicular cancer, while 513 had not. They asked about how often they were using supplements, but also about other potential risk factors, such as smoking, drinking, exercise habits, previous injuries to the region, and family history.

After taking into account all these factors, the team found that men who took muscle-building supplements had on average a 65 percent greater risk of developing testicular cancer compared to those who didn’t. And this risk increased to 177 percent if the men used more than one type of supplement. It also shot up significantly if the men had started using supplements before the age of 25, or for more than three years.

The results have been published in the British Journal of Cancer, and offer epidemiologists an important insight into what causes the poorly understood cancer, and why it’s on the rise. “Testicular cancer is a very mysterious cancer,” said Zheng. “None of the factors we’ve suspected can explain the increase.”

Of course, correlation doesn’t equal causation, and more work needs to be done to find out exactly what’s happening here. But the researchers think they now have a solid lead to follow, and the best part is that, if this link is confirmed, it’ll be simple and quick for men to significantly reduce their testicular cancer risk.

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Toiletry chemicals linked to testicular cancer and male infertility cost EU millions, report says


Nordic Council calls on EU to ban damaging compounds found in household products that cost millions due to their harmful impact on male reproductive health
endocrine disruptor chemicals ( EDC ) hormone-mimicking chemicals : cleaning products placed shelf
Endocrine disruptor compounds (EDCs) routinely used in household items could cause serious health damage, a study has found.

endocrine disruptor chemicals ( EDC ) hormone-mimicking chemicals : cleaning products placed shelf
The hormone-mimicking chemicals used routinely in toiletries, cosmetics, medicines, plastics and pesticides cause hundreds of millions of euros of damage to EU citizens every year, according to the first estimate of their economic impact.

The endocrine disruptor compounds (EDCs) are thought to be particularly harmful to male reproductive health and can cause testicular cancer, infertility, deformation of the penis and undescended testicles.

The new report, from the Nordic Council of Ministers, focuses on the costs of these on health and the ability to work but warns that they “only represent a fraction of the endocrine-related diseases” and does not consider damage to wildlife. Another new study, published in a medical journal, showed an EDC found in anti-perspirants reduced male fertility by 30%.

The Nordic Council, representing the governments of governments of Denmark, Finland, Iceland, Norway and Sweden, is demanding the European Union speeds up its plan to identify, assess and ban harmful EDCs. Sweden is already taking legal action against the EU over its missed deadlines, which it blamed on lobbying by the European chemical industry.

“I am not happy that taxpayers have to pay for the damage caused by EDCs, while industry saves money by not investigating their chemicals properly,” said Danish environment minister Kirsten Brosbøl on publication of the new report.

Michael Warhurst, of campaign group Chem Trust, said: “Companies should focus on developing and producing products that don’t contain hormone disruptors and other problem chemicals. This will give them a competitive advantage as controls on these chemicals become stricter around the world – and as consumers become more aware of this issue.”

The report, called The Cost of Inaction, uses the extensive health records collected by the Nordic countries to determine the incidence of the male reproductive health problems linked to EDCs and then uses Swedish data to estimate costs. These are extrapolated to the population of the EU’s 28 nations.

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The report also assesses the proportion of the health problems attributable to EDCs, with a central estimate of 20%, leading to a conclusion that the male reproductive health problems cost the EU €592m (£470m) a year. The report states: “Minimising exposure to endocrine disruptors will not only remove distress and pain for the persons (and the wildlife) affected, it will also save the society from considerable economic costs.”

The EU, which would be the first authority in the world to regulate EDCs, is currently conducting a public consultation on a scientific method to identify the chemicals, which ends on 16 January. In 2011, the UK and German governments lobbied to EU to restrict the definition of EDCs to only the most potent chemicals, a proposal described as a “loophole” by critics.

Peter Smith, executive director for product stewardship at CEFIC, which represents the European chemical industry, said the Nordic report attribution of health problems to EDCs was “arbitrary”. He said: “The link between exposure to a chemical and an illness has not been shown in many cases. The authors themselves say they have some trouble with causality.”

Smith said the delays to EDC regulation in the EU did not suit the industry. “Nobody is happy with the delays. But we would prefer it to be permanent and right rather than temporary and wrong.” He said case-by-case rigorous assessment was needed and that any precautionary action had to be proportional to the evidence of harm.

However, Professor Andreas Kortenkamp, a human toxicologist at Brunel University London in the UK, said the epidemiological work needed to prove causation is very difficult. For example, he said, analysing links to birth defects would having taken tissue samples from mothers before they gave birth.

“Hard evidence for effects in humans is difficult to demonstrate, though there are some exceptions,” he said. “But there is very good, strong evidence from animal and cell line test systems. The chemical industry only likes to emphasis the first part of that.” He said precaution was the only safe approach and said the Nordic report was good work.

“Industry lobbying has put regulation back by 3-5 years, which was entirely the intention,” said Kortenkamp, who led a 2012 review of EDCs for the EU which found new regulations were needed. “Every year of no regulation means millions of euros to the industry. That is what it is all about.”

In 2012, the World Health Organiation and the UN environment programme published a major report on the state of EDC science, which concluded that communities across the globe were being exposed to EDCs and their associated risks and that urgent research on the health and environmental impacts was needed. Dr Maria Neira, the WHO’s director for public health and environment said at the time: “We all have a responsibility to protect future generations.” Another review in 2012 by the European Environment Agency advised “a precautionary approach to many of these chemicals until their effects are more fully understood.”

Testicular Cancer


Germ cell tumor is the most frequent malignant tumor type in young men, with a steep rise in incidence in recent years. The majority of patients with advanced disease will be cured, but there is a need to improve the outcome of poor-risk patients. For this patient category, and for patients who relapse following standard, first-line, cisplatin-based chemotherapy, the role of high-dose chemotherapy (HDCT) is still a matter of debate. With cure rates > 90% in the whole group of testicular cancer patients, long-term morbidity has become increasingly important.

Objective

Highlights of the American Society of Clinical Oncology 2010 Annual Meeting pertinent to these key issues in the field of testicular cancer are discussed.

Conclusions

The role of HDCT as first-line treatment of stage I seminoma in poor-prognosis patients or in second-line therapy as salvage treatment has not been established. The clinical approach to stage I seminoma patients varies considerably between European countries, such as Scandinavian countries and Spain. Long-term testicular cancer survivors are at increased risk of cardiovascular disease, particularly after treatment with chemo- and radiotherapies.

Take Home Message

High-dose chemotherapy has not been shown to be superior in first-line treatment of stage I seminoma in poor-prognosis patients or as a salvage regimen in second-line therapy. Prospective trials, adequately powered to detect a clinically meaningful difference, are needed to address these questions.

source: European urology supplement