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Fertility Distress, Sexual Disturbances Found Among Testicular Cancer Survivors
A DGReview of :"Sexual function and fertility after treatment of testicular cancer"
Current Opinion in Urology
11/02/2000
By Mark Greener
Sexual dysfunction and infertility are common among men who survive testicular cancer, notes a review by authors from Hannover University Medical School and Eberhard-Carls-University, Tübingen, Germany.
Testicular cancer is most common malignancy among men aged between 20 and 34 years. Today's cisplatin-based regimens, however, mean that the overall cure rate is greater than 70 to 85 percent, even among patients with disseminated germ cell tumours.
Around half of patients with testicular germ cell tumours who undergo orchiectomy show abnormal sperm concentrations, the review remarks. However, modern surgical techniques -- for example, nerve-sparing retroperitoneal lymph node dissection -- preserve antegrade ejaculation.
Despite this, paternity rates are between 15 and 30 percent lower among testicular cancer survivors compared to the normal population. The reduced paternity rates may reflect the impact of endocrine changes that undermine the contralateral testicle's normal function after unilateral orchiectomy.
Against this background, the authors note that "fertility distress and sexual disturbances" undermine quality of life among men who survive testicular cancer. They suggest that the impact is especially pronounced because men who develop testicular cancer tend to be in the prime of their physical, sexual and reproductive life. However, intracytoplasmatic sperm injection may allow the man to conceive, even if few sperm are present in his ejaculate.
The authors called for long-term investigations to clarify the impact of different treatments on fertility and sexual life. In particular, they called for studies to identify patients likely to be at increased risk of developing physical and psychological problems following treatment for testicular cancer.
"Sexual function and fertility after treatment of testicular cancer"
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