Abstract
Testicular germ cell tumors (TGCTs) are prevalent in males of reproductive age. Among the available therapeutic choices, pelvic radiotherapy (RT) and simple surveillance (SURV) are usually pursued. However, RT is considered to have life-threatening effects on testicular functions. In this study we sought to clarify this issue by evaluating sperm parameters and sex hormones in 131 TGCTs RT-treated-patients at both baseline (T0) and 12 (T1) and 24 months (T2) of follow-up. An age-matched group of 61 SURV patients served as control. Sperm parameters were comparable between SURV and RT at T0.The RT group showed a significant reduction of all sperm parameters at T1 (all P values < 0.05 vs T0 and vs SURV at T1) and increased levels of sperm aneuploidies, with some degree of recovery at T2. On the other hand, despite normal levels of total testosterone being detected in both groups, luteinizing hormone (LH) levels in the RT group progressively increased at T1 and T2 with a relative risk of developing subclinical hypogonadism of 3.03 (95% CI: 1,50–6,11) compared to SURV. Again, compared to SURV, exposure to RT was associated with a 5.78 fold (95% CI: 2,91–11,48) risk of developing vitamin D insufficiency. These data suggest a likely RT-dependent impairment of the Leydig cell compartment.
Highlights
Testicular germ cell tumors (TGCTs) are the most frequent cancer disease in young males aged from 15 to 40 years, with an outstanding increase in incidents over the past 50 years [1, 2]
Whilst on a site, the germ cell compartment is known to be highly sensitive to chemotherapy [9], the Leydig cell compartment is affected by radiation, resulting in subnormal/normal levels of serum testosterone values and/or increased luteinizing hormone (LH)
Adverse effects associated with post-orchiectomy treatments for TGCTs represent a major matter of concern because of their potentially deleterious effects on spermatogenesis, sperm aneuploidies and gonadal hormonal function [14]
Summary
Testicular germ cell tumors (TGCTs) are the most frequent cancer disease in young males aged from 15 to 40 years, with an outstanding increase in incidents over the past 50 years [1, 2]. Whilst on a site, the germ cell compartment is known to be highly sensitive to chemotherapy [9], the Leydig cell compartment is affected by radiation, resulting in subnormal/normal levels of serum testosterone values and/or increased luteinizing hormone (LH). This would be relevant after orchiectomy in testicular cancer patients, in which the cytotoxic effect of ionizing radiation on the contralateral testis could prevent its compensatory growth. Available studies report conflicting results to this regard and it is presently not possible to identify patients at high risk of long-term hypogonadism as a consequence of RT treatment [10]
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