The Effects of Cancer and Cancer Treatments on Male Reproductive Function

Summary and Introduction

Summary

In male cancer patients, surgery, radiotherapy and chemotherapy can be followed by transient or permanent infertility by affecting ejaculatory or erectile function, or by impairing spermatogenesis. Cancer specialists should, therefore, discuss the impact of different therapies on fertility with their patients prior to treatment, and consider fertility-preserving measures before and during treatment, such as nerve-sparing operative techniques, adequate testicular shielding during radiotherapy and the avoidance of unnecessary gonadotoxic chemotherapy. Pretreatment sperm-cell cryopreservation should be offered, even in cases where the individual's risk of post-treatment infertility might seem minimal or if it might require testicular sperm-cell extraction. Samples that are severely oligospermic should also be cryopreserved. Post-treatment ejaculatory or erectile dysfunction can be reversed pharmacologically, but the success rate varies with the extent of neurologic sequelae of the treatments used. At present there is no established method to stimulate post-treatment impaired spermatogenesis, although currently available assisted reproductive techniques overcome some of the existing problems of infertility in cancer survivors, and ongoing research will hopefully increase these possibilities. A multidisciplinary approach that depends on close cooperation between relevant medical specialists is central to achieving such advances.

Introduction

Approximately 15% of newly diagnosed male cancer patients are less than 55 years of age at diagnosis, and approximately 26% of these patients less than 20 years of age.^[1,2] Acute lymphoblastic leukemia and brain tumors are the most frequently occurring malignancies in children aged 15 years or younger, whereas malignant lymphoma, testicular cancer, lung cancer and malignant melanoma are most common among males aged 15–54 years. The 5-year survival rate for male cancer patients below the age of 15 years approaches 75%,^[3] and for those aged 15–44 years the 5-year relative survival rate is 61%.^[4] For many of these men, the question arises: how will the malignancy or its treatment affect future fertility? This could also be relevant for some older men with younger wives, who might have plans for parenthood. Registered data indicate that the 15-year cumulative probability of post-treatment paternity is approximately 32% in cancer patients diagnosed between the ages of 15 and 45 years (Figure 1).^[5]