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Fertility preservation in testicular cancer

In a study of men with testicular cancer, published in BJU International, increasing tumour size relative to testis size was linked with a reduced ability to produce sperm. The study’s findings can be summarised into the rule of 50s: men with a testis tumour occupying greater than 50 per cent of the testis have less than a 50 per cent chance of sperm production in the affected testis.

The retrospective review included 103 testicular germ cell tumours (TGCTs) in men who underwent radical orchidectomy at Guy's Hospital, London, between 2011 and 2015. Primary outcome measures included the presence and characteristics of spermatogenesis. Secondary outcome measures included the presence of testicular microlithiasis, tumour characteristics and tumour markers.

The study found that spermatogenesis was present in 70 per cent of the patients, being widespread in 63 per cent and focal in 38 per cent. Neither tumour type, stage, presence of microcalcification nor tumour markers predicted spermatogenesis. Men with a percentage testis tumour occupation (PTTO) greater than 50 per cent of the testis were 82 per cent less likely to have spermatogenesis than a those with a PTTO less than 50 per cent.

Lead author Jemma Moody from Andrology Department at Guy's Hospital said: “Up to 24 per cent of men presenting with testicular cancer have no sperm in their ejaculate at diagnosis, and the treatment can cause further insult to sperm production.”

“The rule of 50s can help guide patients and clinicians at diagnosis regarding fertility counselling and treatment, including referral of patients with no sperm in their ejaculate for onco-microTESE, which involves surgical sperm retrieval from the affected testicle at the time of cancer surgery,” she added.


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