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FERTILITY AFTER TESTICULAR CANCER TREATMENT
Vol. 179, No. 4, Supplement, Sunday, May 18, 2008
THE JOURNAL OF UROLOGY®
177
markers.The location of each residual mass, as assessed by CT Scan ZDVFODVVL¿HGDFFRUGLQJWRWKHTXDGUDQWVUHSRUWHGE\:HLVVEDFK -8URO 1987). All surviving patients (mean follow-up 49 months, 55 surviving patients, mean age 25.0 + 8.2 yo) were sent SF-36v2 (General mental and physical health) and IIEF-15 (sexual quality of life) and CIVIQ YHQRXV LQVXI¿FLHQF\ TXDOLW\ RI OLIH TXHVWLRQQDLUHV 5HODWLRQVKLSV between qualitative (quadrants, resection of vena cava inferior, arterial replacement) and QoL scores were sought by bilateral exact Fisher’s test. RESULTS: No differences were observed in physical component scores (PCS) and mental component scores (MCS) between cancer patients and age-matched controls provided by the SF36v2 TM+HDOWKVXUYH\PDQXDO7KH&,9,4TXHVWLRQQDLUHVKRZHGDVLJQL¿FDQW LQFUHDVHLQYHQRXVLQVXI¿FLHQF\ZKHQUHVHFWLRQRIWKHYHQDFDYDLQIHULRU (n=14) was not reconstructed (n=5) by a reinforced prosthesis supporting systematic reconstruction. The mean IIEF scores were 22,92 /30 (Erectile Function), 7,2/10 (Orgasmic Function), 8/10 (Intercourse Satisfaction), 8/10 (Global Satisfaction), 9,5/15 (Sexual Desire). The distribution in percent of the maximum possible scores according to quadrants is here after presented (Black : quadrant resected, light gray: rest of the population). It shows that resection of the hypogastric plexus (quadrant 10) negatively impacted on all aspects of the sexual quality of life. CONCLUSIONS: Overall quality of life is preserved after VXUJLFDOUHVHFWLRQRIUHWURSHULWRQHDOUHVLGXDOPDVVHV+RZHYHUVSHFL¿F locations, such as the hypogastric plexus quadrant, are associated with decreased sexual function. Source of Funding: None
505 FERTILITY AFTER TESTICULAR CANCER TREATMENT Nicolai Leonhartsberger*, Georg Bartsch, Hannes Steiner. Innsbruck, Austria. INTRODUCTION AND OBJECTIVE: Patients with testicular cancer have excellent survival rates due to recent advances in chemotherapy and operative treatments. Since these young patients often have not yet attempted to father children, fertility remains one of the PDLQFRQFHUQVRIVXUYLYRUV:HDQDO\]HGIHUWLOLW\VWDWXVUHWURVSHFWLYHO\ in 304 patients after treatment for testicular cancer. METHODS: Information concerning fertility was obtained LQ SDWLHQWV ZLWK KLVWRORJLFDOO\ FRQ¿UPHG JHUP FHOO WXPRU *&7 Patients were treated between 1987 and 2007 with cisplatin-etoposidebased or carboplatin-based chemotherapy according to clinical stage after orchiectomy. Furthermore 181 patients underwent uni- or bilateral retroperitoneal lymph nodes resection (RPLND) depending on tumorstage. Fertility was assessed by means of a sent, standardised questionnaire focused on reproductive events that ocurred before and after treatment. RESULTS: Seminoma accounted for 42.1% of tumors (n=128) and NSGCT/Mixed GCT accounted for 57.9% of tumors (n=176). Before they were diagnosed with testicular cancer (TC), 144 (47.4%) patients had achieved pregnancy with their partners. After treatment, 88 men attempted to achieve pregnancy (including four patients with loss of DQWHJUDGHHMDFXODWLRQ DQG¿QDOO\ VXFFHHGHG,QSDWLHQWVZLWK higher clinical stages paternity rate declined (stage III 40.0%, stage II 42.0%, stage I 53.1%). Carboplatin-based chemotherapy seems to have a better outcome concerning fertility. In four patients who obtained four cycles of chemotherapy and RPLND no pregnancy could be achieved. No correlation to tumor histology could be found.
Desired paternity, n=88 Paternity after TC, n=44
2x 2xPEB+ 3/4xPEB+ 3x PEB RPLND Carboplatin RPLND RPLND Stage I 29
21
17
17
17 (58.6%)
10 9 6 (47.6%) (52.9%) (35.3%)
Stage II
Stage III
19
5
4
64
2 (50%)
34 8 (53.1%) (42%)
2 (40%)
CONCLUSIONS: Fertility in patients with testicular cancer decreases with increasing amount of therapy. The quantity of cycles of the chemotherapy has the most deleterious effect on fertility once ejaculation can be preserved during RPLND. Source of Funding: None
THE JOURNAL OF UROLOGY®
177
markers.The location of each residual mass, as assessed by CT Scan ZDVFODVVL¿HGDFFRUGLQJWRWKHTXDGUDQWVUHSRUWHGE\:HLVVEDFK -8URO 1987). All surviving patients (mean follow-up 49 months, 55 surviving patients, mean age 25.0 + 8.2 yo) were sent SF-36v2 (General mental and physical health) and IIEF-15 (sexual quality of life) and CIVIQ YHQRXV LQVXI¿FLHQF\ TXDOLW\ RI OLIH TXHVWLRQQDLUHV 5HODWLRQVKLSV between qualitative (quadrants, resection of vena cava inferior, arterial replacement) and QoL scores were sought by bilateral exact Fisher’s test. RESULTS: No differences were observed in physical component scores (PCS) and mental component scores (MCS) between cancer patients and age-matched controls provided by the SF36v2 TM+HDOWKVXUYH\PDQXDO7KH&,9,4TXHVWLRQQDLUHVKRZHGDVLJQL¿FDQW LQFUHDVHLQYHQRXVLQVXI¿FLHQF\ZKHQUHVHFWLRQRIWKHYHQDFDYDLQIHULRU (n=14) was not reconstructed (n=5) by a reinforced prosthesis supporting systematic reconstruction. The mean IIEF scores were 22,92 /30 (Erectile Function), 7,2/10 (Orgasmic Function), 8/10 (Intercourse Satisfaction), 8/10 (Global Satisfaction), 9,5/15 (Sexual Desire). The distribution in percent of the maximum possible scores according to quadrants is here after presented (Black : quadrant resected, light gray: rest of the population). It shows that resection of the hypogastric plexus (quadrant 10) negatively impacted on all aspects of the sexual quality of life. CONCLUSIONS: Overall quality of life is preserved after VXUJLFDOUHVHFWLRQRIUHWURSHULWRQHDOUHVLGXDOPDVVHV+RZHYHUVSHFL¿F locations, such as the hypogastric plexus quadrant, are associated with decreased sexual function. Source of Funding: None
505 FERTILITY AFTER TESTICULAR CANCER TREATMENT Nicolai Leonhartsberger*, Georg Bartsch, Hannes Steiner. Innsbruck, Austria. INTRODUCTION AND OBJECTIVE: Patients with testicular cancer have excellent survival rates due to recent advances in chemotherapy and operative treatments. Since these young patients often have not yet attempted to father children, fertility remains one of the PDLQFRQFHUQVRIVXUYLYRUV:HDQDO\]HGIHUWLOLW\VWDWXVUHWURVSHFWLYHO\ in 304 patients after treatment for testicular cancer. METHODS: Information concerning fertility was obtained LQ SDWLHQWV ZLWK KLVWRORJLFDOO\ FRQ¿UPHG JHUP FHOO WXPRU *&7 Patients were treated between 1987 and 2007 with cisplatin-etoposidebased or carboplatin-based chemotherapy according to clinical stage after orchiectomy. Furthermore 181 patients underwent uni- or bilateral retroperitoneal lymph nodes resection (RPLND) depending on tumorstage. Fertility was assessed by means of a sent, standardised questionnaire focused on reproductive events that ocurred before and after treatment. RESULTS: Seminoma accounted for 42.1% of tumors (n=128) and NSGCT/Mixed GCT accounted for 57.9% of tumors (n=176). Before they were diagnosed with testicular cancer (TC), 144 (47.4%) patients had achieved pregnancy with their partners. After treatment, 88 men attempted to achieve pregnancy (including four patients with loss of DQWHJUDGHHMDFXODWLRQ DQG¿QDOO\ VXFFHHGHG,QSDWLHQWVZLWK higher clinical stages paternity rate declined (stage III 40.0%, stage II 42.0%, stage I 53.1%). Carboplatin-based chemotherapy seems to have a better outcome concerning fertility. In four patients who obtained four cycles of chemotherapy and RPLND no pregnancy could be achieved. No correlation to tumor histology could be found.
Desired paternity, n=88 Paternity after TC, n=44
2x 2xPEB+ 3/4xPEB+ 3x PEB RPLND Carboplatin RPLND RPLND Stage I 29
21
17
17
17 (58.6%)
10 9 6 (47.6%) (52.9%) (35.3%)
Stage II
Stage III
19
5
4
64
2 (50%)
34 8 (53.1%) (42%)
2 (40%)
CONCLUSIONS: Fertility in patients with testicular cancer decreases with increasing amount of therapy. The quantity of cycles of the chemotherapy has the most deleterious effect on fertility once ejaculation can be preserved during RPLND. Source of Funding: None