SPERMATOGENESIS AFTER UNILATERAL ORCHIECTOMY FOR TESTICULAR CANCER IN PATIENTS FOLLOWING SURVEILLANCE POLICY

JACOBSEN, K. D.
THEODORSEN, L.
FOSSA, S. D.

From the Department of Medical Oncology and Radiotherapy, Central Laboratory, The Norwegian Radium Hospital, Oslo, Norway

Editor’s Note:This article is the third of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 230 and 231.

Accepted for publication July 21, 2000.

Journal of Urology 165(1):p 93-96, January 2001.

Purpose

Only limited information is available on the natural course of spermatogenesis in patients with testicular cancer who underwent unilateral orchiectomy and surveillance. We analyze long-term exocrine function of the remaining testicle in patients following surveillance policy.

Materials and Methods

Sperm counts and serum follicle-stimulating hormone (FSH) levels were available in 60 nonrelapsing cases approximately 3 weeks (baseline), 1 year and 2 years or greater after orchiectomy. Contralateral testicular cancer subsequently developed in 2 men.

Results

At baseline 36 patients were normospermic (10 or greater × 10⁶/ml.), 7 were azoospermic and 17 were oligospermic. After 1 year 45 patients were normospermic. Mean sperm concentrations increased significantly from 26 to 39 × 10⁶/ml. during year 1 after orchiectomy. Elevated serum FSH at baseline was associated with incomplete recovery of spermatogenesis, although sperm counts improved in 3 of 7 patients. Furthermore, in the 2 initially oligospermic patients with subsequent contralateral testicle cancer transient normospermia was observed after 1 year. After orchiectomy fatherhood was recorded in 28 men and was assisted by fertilization using fresh semen in 2.

Conclusions

In nonrelapsing testicular cancer cases on surveillance, initially reduced spermatogenesis recovers during year 1 after orchiectomy especially if baseline serum FSH is normal. Transient recovery also occurs in patients in whom contralateral testicular cancer subsequently develops. In high risk patients and in initially oligospermic patients with plans for future fatherhood, the period of improved spermatogenesis may be used for multiple semen cryopreservations enabling subsequent assisted fertilization.