Reproductive aspects of testicular germ cell cancer: general discussion.
Gonadal function is affected by both chemotherapy and radiotherapy in the treatment of testicular cancer. Leydig cells are more resistant than germ cells, but endocrine function is also affected. Sex life is affected by treatment for testicular cancer but major permanent sexual dysfunction is not common. Radiotherapy is more damaging to Leydig cells than chemotherapy and can also cause direct effects on Sertoli cells. Leydig cell dysfunction following chemotherapy is dose-dependent. Serum FSH levels may be elevated at the time of primary orchidectomy and this may be used to predict ultimate fertility in these patients. Fertility does not recover if FSH levels are greater than 24 IU/l which is twice the upper limit of normal. Retroperitoneal lymph node dissection does not cause erectile dysfunction, but may cause dry ejaculation unless a nerve sparing operation is performed by an experienced surgeon. LHRH analogues causes reduced testosterone secretion, impotence and loss of libido, and requires exogenous androgen therapy. CIS can be eradicated by 20 Gy fractionated radiotherapy. This dose has been shown to have some effect on Leydig cell function but this is not clinically significant in the first 5 years of follow-up. The effects of lower doses of irradiation, which may be less injurious to Leydig cells, are currently being investigated. The effects of chemotherapy on CIS is as yet unpredictable.