Impact of Bep or Carboplatin Chemotherapy on Testicular Function and Sperm Nucleus of Subjects with Testicular Germ Cell Tumor

Abstract

Young males have testicular germ cells tumors (TGCT) as the most common malignancy and its incidence is increasing in several countries. Besides unilateral orchiectomy (UO), the treatment of TGCT may include surveillance, radiotherapy, or chemotherapy (CT), basing on tumor histology and stage of disease. It is well known that both radio and CT may have negative effects on testicular function, affecting spermatogenesis, and sex hormones. Many reports investigated these aspects in patients treated with bleomycin, etoposide, and cisplatin (BEP), after UO. In contrast no data are available on the side effects of carboplatin treatment in these patients. We included in this study 212 consecutive subjects who undergone to sperm banking at our Andrology and Human Reproduction Unit after UO for TGCT. Hundred subjects were further treated with one or more BEP cycles (BEP-group), 54 with carboplatin (CARB group), and 58 were just surveilled (S-group). All patients were evaluated for seminal parameters, sperm aneuploidy, sperm DNA, sex hormones, volume of the residual testis at baseline (T0) and after 12 (T1) and 24 months (T2) from UO or end of CT. Seminal parameters, sperm aneuploidies, DNA status, gonadic hormones, and testicular volume at baseline were not different between groups. At T1, we observed a significant reduction of sperm concentration and sperm count in the BEP group versus baseline and versus both Carb and S-group. A significant increase of sperm aneuploidies was present at T1 in the BEP group. Similarly, the same group at 1 had altered sperm DNA integrity and fragmentation compared with baseline, S-group and Carb group. These alterations were persistent after 2 years from the end of BEP treatment. Despite a slight improvement at T2, the BEP group had still higher percentages of sperm aneuploidies than other groups. No impairment of sperm aneuploidies and DNA status were observed in the Carb group both after 1 and 2 years from the end of treatment. Despite preliminary, these data demonstrate that in selected patients with TGCTs CT with carboplatin represents a therapeutic option that that seems to not affect sex hormones, spermatogenesis, and sperm nucleus.

Fertility managment in testicular cancer: the need to establish a standardized and evidence‐based patient‐centric pathway

“…Although there is an abundance of data reporting on the impact of BEP therapy, data reporting on the impact of carboplatin are sparse. Nevertheless, a recent study found that one cycle of carboplatin had no effect on fertility or sex hormones, suggesting that this regimen does not affect spermatogenesis .…”

“…© 2018 The Authors BJU International © 2018 BJU International one cycle of carboplatin had no effect on fertility or sex hormones, suggesting that this regimen does not affect spermatogenesis [47].…”

A Qualitative Analysis of the Impact of Carboplatin AUC 10 on Physical, Work Functioning and Bone Marrow Toxicity Among Seminoma Patients – A Single-centre Experience

“…The small sample size and bias, especially ascertainment bias, which is introduced in any cohort study, limit this study. Although it is known that carboplatin does not affect fertility compared to BEP (33), this study did not look at the fertility outcomes in these patients. Future studies should also incorporate long-term cardiovascular events in carboplatin-treated patients.…”

Hypertestosteronemia and Infertility from a Mediastinal Extragonadal Germ Cell Tumor

“…He was not referred for surgical sperm extraction before chemotherapy because of the low risk of gonadal toxicity from 1 carboplatin cycle. 3 At last follow-up, his testosterone was normal (18.7 nmol/L) ( Figure 4) without evidence of disease recurrence, and the couple was referred for microsurgical sperm retrieval followed by in vitro fertilization with intracytoplasmic sperm injection. 4 Extragonadal germ cell tumor treatment and prognosis depend on factors such as cancer type, tumor location, and tumor size.…”