Sperm analysis and serum follicle-stimulating hormone levels before and after adjuvant single-agent carboplatin therapy for clinical stage I seminoma.
OBJECTIVE
During the past 25 years, radiotherapy has been considered the standard adjuvant treatment for clinical Stage I seminoma after orchiectomy. However, the late effects of this treatment have prompted a re-examination of the alternatives, including surveillance and adjuvant administration of carboplatin. To our knowledge, the present clinical study is the first to report the effects of two adjuvant courses of single-agent carboplatin on the pituitary-testicular axis and on sperm analysis.


METHODS
Twenty-two patients with clinical Stage I seminoma participated in a prospective investigation of gonadal function before and after carboplatin therapy. After orchiectomy but before chemotherapy, blood samples for determination of follicle-stimulating hormone (FSH) serum levels were obtained from all 22 patients. Seventeen patients provided a semen sample at the same time, but 5 were unable to do so. At the end of chemotherapy, all 22 patients provided repeated semen samples starting 1 year after the termination of treatment and continuing at intervals of 12 months. FSH serum levels were determined at the same time. The study period was 48 months.


RESULTS
Before chemotherapy, 2 patients (12%) had azoospermia, 9 (53%) had oligospermia, and 6 (35%) had normospermia. During the study period, sperm counts continued to increase in all patients. After 4 years, 7 patients (32%) had oligospermia and 15 (68%) normospermia. The mean prechemotherapy FSH level (15.5 IU/L) was increased in accordance with subnormal spermatogenesis, but a constant trend toward normalization was observed thereafter.


CONCLUSIONS
Our results show recovery of spermatogenesis after adjuvant single-agent carboplatin for clinical Stage I seminoma in a remarkably high percentage of patients.
Department of Urology, University of Vienna, Austria.
W J
WJ
Reiter
C
C
Kratzik
T
T
Brodowicz
A
A
Haitel
A
A
Pokorny
C C
CC
Zielinski
M
M
Marberger
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011446:Prospective Studies; D018239:Seminoma / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D013076:Sperm Count; D013081:Sperm Motility; D013736:Testicular Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology
D000970:Antineoplastic Agents; D005640:Follicle Stimulating Hormone; D016190:Carboplatin