Erectile dysfunction in men treated for testicular cancer

Abstract

Objective• To study the unique characteristics of erectile dysfunction (ED) in a population of men who developed ED after testicular cancer (TC) diagnosis and treatment. Patients and Methods• All men treated for TC who presented for sexual function evaluation were included in an institutional database.• All men underwent standard evaluation including a history/physical examination, completion of the International Index of Erectile Function (IIEF) questionnaire, testosterone/gonadotropin measurement and penile duplex Doppler ultrasonography (DUS). Results• The study population comprised 76 men whose mean (SD) age was 29 (8) years and of whom 25% were married/had a partner. In all, 39% of the patients had seminoma and 61% had non-seminomatous germ-cell tumour (NSGCT).• A total of 66% of patients with seminoma underwent radiation therapy. Of the patients with NSGCT, 79% received chemotherapy, 18% underwent primary retroperitoneal lymph node dissection (RPLND) and 20% underwent post-chemotherapy RPLND.• The mean (SD) time before seeking sexual medicine consultation was 12 (7) months after treatment completion, the median (range) number of vascular risk factors was 0 (0-2) and the mean (SD) remaining testis volume was 16 (8) mL. Mean (SD) total testosterone, luteinizing hormone, follicle-stimulating hormone levels were 312 (186) ng/dL, 9 (7) IU/mL, 17 (12) IU/mL. A total of 26% of patients had total testosterone levels <300 ng/dL. • In all, 84% of patients complained primarily of loss of erection-sustaining capability and 24% had episodes of transient ED before TC diagnosis. The mean (SD) IIEF erectile function domain score was 16 (7).• All the patients (100%) had a normal DUS. Mean (SD) peak systolic and end-diastolic velocities were 48 (16) Conclusions• Men with TC presenting with ED after treatment appear uniformly to have normal erectile haemodynamics, suggesting adrenaline-mediated ED.• While the majority of TC survivors with ED respond successfully to PDE5i, a significant minority do not.

Infertility with Testicular Cancer

“…All patients had normal Doppler ultrasound, with 9 of 10 responding to Infertility with Testicular Cancer phosphodiesterase type 5 inhibitors; 1 in 4 had low testosterone (<300 ng/dL). 45 Overall, there are significant long-term psychological and sexual effects of testicular cancer treatment, regardless of the modality chosen, including surveillance.…”

Sexual dysfunction in testicular cancer patients subjected to post-chemotherapy retroperitoneal lymph node dissection: a focus beyond ejaculation disorders

“…In addition, erectile dysfunction and other sexual disorders have been reported in patients who received different treatments (chemotherapy, radiotherapy and surgery) for testicular neoplasms and survived cancer. The aetiology remains unclear, as various organic, treatment‐related and psychogenic pathogenetic mechanisms have been proposed in the literature (Hartmann et al ., ; Nazareth et al ., ; Rosendal et al ., ; Eberhard et al ., ; Kim et al ., ; Tal et al ., ).…”

Fertility preservation of patients with testicular cancer

“…A cross‐section of 76 patients with TC was evaluated in order to examine their hemodynamics with penile Doppler ultrasonography as an assessment of the organic factors and graded erectile function by using the International Index of Erectile Function (IIEF). The study concluded that the patients had normal erectile hemodynamics, which suggested that their ED could have been psychogenic . Another study reported that 25.5% of the 143 survivors of TC experienced ED after chemotherapy, RT, or RPLND and the median time to recovery was 60‐70 months, regardless of the modality, based on IIEF scores .…”

“…78 One study reported a wide-range frequency of ED (12%-40%) in patients with TC and attributed it to organic or psychogenic etiologies. 79 A cross-section of 76 patients with TC was evaluated in order to examine their hemodynamics with penile Doppler ultrasonography as an assessment of the organic factors and graded erectile function by using the International Index of Erectile Function (IIEF). The study concluded that the patients had normal erectile hemodynamics, which suggested that their ED could have been psychogenic.…”

“…The study concluded that the patients had normal erectile hemodynamics, which suggested that their ED could have been psychogenic. 79 Another study reported that 25.5% of the 143 survivors of TC experienced ED after chemotherapy, RT, or RPLND and the median time to recovery was 60-70 months, regardless of the modality, based on IIEF scores. 80 Further studies are needed to uncover the correlation among ED, other QoL factors, and fertility in survivors of TC.…”