By Amy Norton and Penny Stern, MD

NEW YORK, Jan 03 - Testicular cancer is a disease that commonly strikes young men, making the effects of treatment on fertility an important concern. Now from Norway come results of a study looking at how well some of these patients recover their ability to produce sperm and what options are open to them.

Dr. Sophie D. Fossa, of The Norwegian Radium Hospital in Oslo, and colleagues studied 60 cancer patients who underwent a surgical procedure called orchiectomy, where the cancerous testicle is removed. Most of the men had regained their normal sperm counts after surgery and almost half became fathers, representing 78 percent of those who were trying to have a child, according to the report in the January issue of The Journal of Urology.

But Fossa noted, it is not unusual for some patients to experience decreased sperm production in the remaining testicle following surgery. "Ten or 15 years ago (many) urologists thought this type of reduced (sperm production) always was permanent. Therefore, aggressive further chemotherapy would be more justified based on the assumption that these men would, in any case, not be able to father a child," the researcher told Reuters Health.

As a consequence, she continued, the type of surgical procedure often performed in the past "destroyed the ejaculatory functions."

But Fossa and her colleagues found that even some patients with initially low sperm counts will experience a "transient" period of normal sperm levels for perhaps a year after surgery.

"Today's surgeons and oncologists have to consider this spontaneous recovery when planning and timing (the) treatment after orchiectomy in a patient who most probably does not have any metastases," Fossa explained. Metastases are secondary cancers that occur when cancer spreads to other sites in the body.

These metastases-free patients may be good candidates for what is termed a "surveillance policy." That is, no further treatment after the orchiectomy.

Fossa also pointed out that patients who have low sperm counts going into orchiectomy were often not given the option to bank their sperm "because of the low success rate of assisted fertilization. This has changed with better methods of in vitro fertilization."

Fossa suggested that patients who are on surveillance should be offered "multiple sperm banking" in the year after their orchiectomy, to take advantage of the temporary rise in sperm production "even in cases who may seem to be 'hopeless' at their first sperm analysis."

Moreover, she added, patients should ask for "at least one sperm analysis at the time of diagnosis, which should be repeated if no further treatment is given and the initial sperm count was low."

In her view, it is important for patients to know that "correct timing and sperm banking may give a true chance of post-orchiectomy fatherhood."

SOURCE: The Journal of Urology 2001;165:93-96.

Copyright © 2000 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.