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      Current practices in fertility preservation in male cancer patients

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          Abstract

          The incidence of a cancer diagnosis in children and young adolescents is increasing. With better treatments, the number of young cancer survivors living through reproductive age is increasing. Fertility preservation of these men and women has become essential and needs to be discussed prior to the start of cancer treatment. Here we review the current guidelines for male oncofertility patients and highlight some of the important gonadotoxic effects of chemotherapy, radiotherapy and surgery. Options for fertility preservation are also discussed along with resources that should be made available to all patients.

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          Cancer statistics, 1999.

          S H Landis, T A Murray, S Bolden … (2015)
          The Surveillance Research Program of the American Cancer Society's Department of Epidemiology and Surveillance Research reports its 33rd annual compilation of cancer frequency, incidence, mortality, and survival data for the United States.
          Article 0 comments Cited 115 times – based on 0 reviews     Review now
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            Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer.

            Nathan C Sheets, Gregg H Goldin, Anne-Marie Meyer … (2012)
            There has been rapid adoption of newer radiation treatments such as intensity-modulated radiation therapy (IMRT) and proton therapy despite greater cost and limited demonstrated benefit compared with previous technologies. To determine the comparative morbidity and disease control of IMRT, proton therapy, and conformal radiation therapy for primary prostate cancer treatment. Population-based study using Surveillance, Epidemiology, and End Results-Medicare-linked data from 2000 through 2009 for patients with nonmetastatic prostate cancer. Rates of gastrointestinal and urinary morbidity, erectile dysfunction, hip fractures, and additional cancer therapy. Use of IMRT vs conformal radiation therapy increased from 0.15% in 2000 to 95.9% in 2008. In propensity score-adjusted analyses (N = 12,976), men who received IMRT vs conformal radiation therapy were less likely to receive a diagnosis of gastrointestinal morbidities (absolute risk, 13.4 vs 14.7 per 100 person-years; relative risk [RR], 0.91; 95% CI, 0.86-0.96) and hip fractures (absolute risk, 0.8 vs 1.0 per 100 person-years; RR, 0.78; 95% CI, 0.65-0.93) but more likely to receive a diagnosis of erectile dysfunction (absolute risk, 5.9 vs 5.3 per 100 person-years; RR, 1.12; 95% CI, 1.03-1.20). Intensity-modulated radiation therapy patients were less likely to receive additional cancer therapy (absolute risk, 2.5 vs 3.1 per 100 person-years; RR, 0.81; 95% CI, 0.73-0.89). In a propensity score-matched comparison between IMRT and proton therapy (n = 1368), IMRT patients had a lower rate of gastrointestinal morbidity (absolute risk, 12.2 vs 17.8 per 100 person-years; RR, 0.66; 95% CI, 0.55-0.79). There were no significant differences in rates of other morbidities or additional therapies between IMRT and proton therapy. Among patients with nonmetastatic prostate cancer, the use of IMRT compared with conformal radiation therapy was associated with less gastrointestinal morbidity and fewer hip fractures but more erectile dysfunction; IMRT compared with proton therapy was associated with less gastrointestinal morbidity.
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              Spermatogenesis after cancer treatment: damage and recovery.

              S Howell, S. Shalet (2004)
              Treatment with cytotoxic chemotherapy and radiotherapy is associated with significant gonadal damage in men, and alkylating agents are the most common agents implicated. The vast majority of men receiving procarbazine-containing regimens for the treatment of lymphomas are rendered permanently infertile, whereas treatment with doxorubicin hydrochloride (Adriamycin), bleomycin, vinblastine, and dacarbazine appears to have a significant advantage, with a return to normal fertility in the vast majority of patients. Cisplatin-based chemotherapy for testicular cancer results in temporary azoospermia in most men, with a recovery of spermatogenesis in about 50% of the patients after 2 years and 80% after 5 years. The germinal epithelium is very sensitive to radiation-induced damage, with changes to spermatogonia following as little as 0.2 Gy. Testicular doses of less than 0.2 Gy had no significant effect on FSH levels or sperm counts, whereas doses between 0.2 and 0.7 Gy caused a transient dose-dependent increase in FSH and reduction in sperm concentration, with a return to normal values within 12-24 months. No radiation dose threshold has been defined above which permanent azoospermia is inevitable; however, doses of 1.2 Gy and above are likely to be associated with a reduced risk of recovery of spermatogenesis; the time to recovery, if it is to occur, is also likely to be dose dependent.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Urol Ann
                Journal ID (iso-abbrev): Urol Ann
                Journal ID (publisher-id): UA
                Title: Urology Annals
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0974-7796
                ISSN (Electronic): 0974-7834
                Publication date (Print): Jan-Mar 2014
                Volume: 6
                Issue: 1
                Pages: 13-17
                Affiliations
                [1]Department of Urology, New York Presbyterian Hospital-Weill Cornell Medical College, Starr 900, New York, NY 10021, USA
                [1 ]Department of Urology, Northwestern University, Feinberg School of Medicine 303 East Chicago Avenue, Tarry 16-703 Chicago, IL 60611-3008, USA
                Author notes
                Address for correspondence: Dr. E. Charles Osterberg, 525 E. 68 th St Starr 900, New York, NY 10021, USA. E-mail: eco2004@ 123456nyp.org
                Article
                Publisher ID: UA-6-13
                DOI: 10.4103/0974-7796.127008
                PMC ID: 3963336
                PubMed ID: 24669115
                SO-VID: c7ab9e63-5d4f-4d43-87bd-f135d5e96d5d
                Copyright © Copyright: © Urology Annals
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 19 February 2013
                Date accepted : 31 July 2013
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Urology
                Keywords: cancer,fertility,fertility preservation,infertility
                Data availability:
                ScienceOpen disciplines: Urology
                Keywords: cancer, fertility, fertility preservation, infertility

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