GONADAL-FUNCTION AFTER MULTIMODALITY TREATMENT IN MEN WITH TESTICULARGERM-CELL CANCER

We evaluated gonadal function in 63 patients with testicular cancer bo th within 1 month of unilateral orchiectomy before further treatment ( pretreatment) and 3 years after treatment discontinuation (post-treatm ent). Sixteen patients underwent orchiectomy alone (group 1), nine pat ients underwent infradiaphragmatic radiotherapy (group 2) and 28 patie nts received four cycles (group 3) and 10 patients received six cycles (group 4) of cisplatin-based chemotherapy (cisplatin, vinblastine and bleomycin-PVB, or cisplatin, etoposide and bleomycin-PEB). Pretreatme nt semen analyses showed reduced sperm cell density, motility and impa ired morphology of spermatozoa in all four groups (p > 0.05). At the s ame time elevated estradiol and decreased serum follicle-stimulating h ormone (FSH) levels in 28.5% of subjects were correlated with high ser um beta human chorionic gonadotropin concentrations. Semen analyses re vealed the lowest values for all parameters after infradiaphragmatic r adiotherapy, Sperm cell count, motility and morphology were significan tly better in patients treated with orchiectomy alone or with a conven tional dose of chemotherapy than in the groups that received radiother apy or high doses of chemotherapy (p 4 0.05). We also observed a corre lation between serum FSH values and sperm cell density for both pretre atment and post-treatment in every group of patients (p < 0.05). Persi stent subclinical Leydig cell dysfunction in groups treated with radio therapy or high doses of chemotherapy was expressed by increased basal luteinizing hormone levels (78% of patients in group 2 vs 60% of pati ents in group 4) (p < 0.05) and by normal testosterone serum values (8 9% of patients in group 2 vs 80% of patients in group 4). Spermatogene sis and Leydig cell function are, therefore, persistently impaired in the majority of testicular cancer patients treated with radiotherapy o r with more intensive chemotherapy.