Improving Male Reproductive Health After Childhood, Adolescent, and Young Adult Cancer: Progress and Future Directions for Survivorship Research

Abstract

Reproductive health is a common concern and often a source of distress for male childhood, adolescent, and young adult cancer survivors. Clinical and epidemiologic research in survivor populations has identified alkylating agent chemotherapy, testicular radiation, and surgery or radiation to the genitourinary organs, lower spine, or the hypothalamic-pituitary region as risk factors for adverse reproductive outcomes, including impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction. Much of the research on male survivors has focused on the outcome of fertility, using spermatogenesis, serum gonadotropins, and paternity as the measures. However, these studies often fail to account for the clinically relevant but difficult-to-quantify aspects of fertility such as sexual function, cancer-related delayed psychosocial development, medical comorbidities, and socioeconomic concerns. Clinical and basic science research has made significant contributions to improving reproductive outcomes for survivors, with recent advancements in the areas of fertility preservation, clinical assessment of reproductive function, and treatment of adverse reproductive outcomes. Furthermore, there is an emerging qualitative literature addressing the psychosexual aspects of male reproductive health, the clinical application of which will improve quality of life for survivors. This review summarizes the current survivorship literature on reproductive health outcomes for male survivors, including the epidemiology of impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction; clinical and laboratory assessment of reproductive function; and established and investigational interventions to preserve reproductive function for patients newly diagnosed and survivors. Although survivorship research has made significant contributions to improving reproductive outcomes, additional scientific progress is needed in the areas of fertility preservation, risk assessment, and psychosexual support with the aim of optimizing reproductive health for current and future survivors.

Hypogonadism in Children with a Previous History of Cancer: Endocrine Management and Follow-Up

“…It was shown that cyclophosphamide with an equivalent dose > 5 g/m 2 and radiation > 2 Gy may induce impaired spermatogenesis [33, 34]. Impaired spermatogenesis may be reversible or permanent, depending on the combinations of treatment and on the cumulative dose of chemotherapy given.…”

“…Awareness and screening for sexual impairment in postpubertal males at risk is important since sexual health has been shown to be important for overall health and quality of life. Next to CCS with androgen deficiency, awareness of sexual impairment is also important in males who have been treated with surgery or radiation involving the lower spinal cord, prostate, distal colon or rectum, due to disruption of the innervation required for erection and ejaculation [33]. These CCS may be referred to the urology department for specific techniques to improve sexual function.…”

Fatherhood Following Treatment for Testicular Cancer: A Systematic Review and Meta-Analyses

“…27,28 Surgery and radiation to the pelvis or lumbar spine has reportedly been linked to sexual dysfunction, as a result of hormonal deficiency and emotional distress. 29 Kenney et al 29 reported that 20% of young adult male cancer patients experienced erectile dysfunction subsequent to treatment, and these findings were supported by several other studies revealing that more than half of all survivors presented with ejaculatory dysfunction following treatment. 3,30 These consequential reproductive outcomes, in relation to fatherhood, can have a detrimental effect on a patient's physical and psychological wellbeing, maintaining relationships, and quality of life.…”

Sexual function, self-esteem, and general well-being in Chinese adult survivors of childhood cancers: a cross-sectional survey

“…It is well-known that treatments for cancer may cause adverse effects on sexual function. Both Kenney et al 20 and Van Dorp et al 21 reviewed the literature regarding reproductive health of male and female survivors. They noted that alkylating agent chemotherapy and gonadal irradiation carried doserelated risks of primary gonadal dysfunction, which affected both sexual function and fertility.…”

“…Until this change occurs, healthcare professionals should provide information regarding the potential adverse effects of treatments on the reproductive system and sexual function, as well as counselling to the survivors; importantly, survivors interviewed in previous studies indicated they had unmet needs for information, support, and counselling. 20…”