Semen quality and reproductive hormones before orchiectomy in men with testicular cancer

Purpose: To obtain information about preorchiectomy gonadal function in pat ients with testicular germ cell cancer to improve the clinical management o f fertility and other andrologic aspects in these men. Patients and Methods: in group 1, a group of 83 consecutive patients with t esticular germ cell cancer (TGCC) investigated before orchiectomy, semen an alysis was carried out in 63 patients and hormonal investigations, includin g measurement of follicle-stimulating hormone, luteinizing hormone (LH), te stosterone, estradiol, sex hormone-binding globulin (SHBG), inhibin B, and human chorionic gonadotropin (hCG), in 71 patients. Hormone levels in patie nts with elevated hCG (n = 41) were analyzed separately. To discriminate be tween general cancer effects and specific effects associated with TGCC, the same analyses were carried out in a group of 45 consecutive male patients with malignant lymphoma (group 2). Group 3 comprised 141 men employed in a Danish company who served as controls in the comparison of semen parameters . As a control group in hormone investigations, 193 men were selected rando mly from the Danish National Personal Register to make up group 4. Results: We found significantly lower sperm concentration (median, 15 x 10( 6)/mL; range, 0 to 128 x 10(6)/mL) and total sperm count (median, 29 x 10(6 )/mL; range, 0 to 589 x 10(6)) in patients with testicular cancer than in p atients with malignant lymphomas (sperm concentration: median, 48 x 10(6)/m L; range, 0.04 to 250 x 10(6)/mL; sperm count: median, 146 x 10(6); range, 0.05 to 418 x 10(6)) (P <.001 and P <.001) and healthy men (sperm concentra tion: median, 48 x 10(6)/mL; range, 0 to 402 x 10(6)/mL; sperm count: media n, 162 x 10(6); range, 0 to 1253 x 10(6)) (P <.001 and P <.001). FSH levels were increased in men with testicular cancer (median, 5.7 IU/L; range, 2.0 to 27 IU/L) compared with both men with malignant lymphomas (median, 3.3 I U/L; range, 1.01 to 12.0 IU/L) and healthy controls (median, 4.1 IU/L; rang e, 1.04 to 21 IU/L) (P =.001 and p =.007, respectively). Surprisingly, we f ound significantly lower LH in the group of men with TGCC (median, 3.6 IU/L ; range, 1.12 to 11.9 lU/L) than in healthy men (median, 4.7 IU/L; range, 1 .3 to 11.9 IU/L) (p =.01). We could not defect any differences between men with testicular cancer and men with malignant lymphomas and healthy men wit h regard to serum levels of testosterane, SHBG, and estradiol. Men with tes ticular cancer who herd increased hCG levels had significantly lower LH and significantly higher testosterone and estradiol than those without detecta ble hCG levels. Conclusion: Spermatogenesis is already impaired in men with testicular canc er before orchiectomy. Neither local suppression of spermatogenesis by tumo r pressure nor a general cancer effect seems to fully explain this impairme nt. The most likely explanation is preexisting impairment of spermatogenesi s in the contralateral test is in men with testicular cancer. The question of whether also a pre-existing Leydig cell dysfunction is present in men wi th testicular cancer could not be answered in this study because the tumor seems to have a direct effect on the Leydig cells. Men with testicular canc er had low LH values as compared with controls. We speculate that increased intratesticular level of hCG also in men without measurable serum hCG may play a role by exerting LH-like effects on the Leydig cells, causing increa sed testosterone and estrogen levels and low LH values in the blood. (C) 19 99 by American Society of Clinical Oncology.