Long-term effects on sexual function and fertility after treatment of testicular cancer

This retrospective study evaluates the types and incidences of sexual distu rbances and fertility distress in patients cured from testicular cancer and examines whether there is an effect resulting from different treatment mod alities. A self-reported questionnaire was sent to 124 randomly selected pa tients who were treated at Hanover University Medical School between 1970 a nd 1993. Ninety-eight patients were included in the study. representing a r esponse rate of 78%. All patients had been in complete remission (CR) for a t least 24 months. The median age at diagnosis was 28 years (range 17-44). The median follow-up at the time of study was 12.0 years (range 2.8-25.6). Twenty patients (20%) had been treated for seminomatous and 78 patients (80 %) for non-seminomatous germ cell tumours. Treatment included surveillance (7%), primary retroperitoneal lymph node dissection (RPLND) (13%), chemothe rapy (CT) (33%), CT + secondary resection of residual retroperitoneal tumou r mass (SRRTM) (43%) and infradiaphragmatic radiotherapy (4%). Patients rec eiving two treatment modalities (CT+SRRTM) reported more frequent an unfulf illed wish for children. inability of ejaculation was clearly associated wi th RPLND and SRRTM. Subjective aspects of sexuality, like loss of sexual dr ive and reduced erectile potential, occurred only in a minority of patients after treatment. No abnormalities were observed concerning the course of p regnancies of partners. In conclusion, sexual dysfunction and infertility a re common long-lasting sequelae in testicular cancer survivors affecting ap proximately 20% of patients. The relative risk for infertility appeared to be elevated for patients treated with the combination of CT+SRRTM. Twenty-o ne of 40 patients were able to fulfil their wish for children, and no conge nital abnormalities were observed in these children.