Predictors of spermatogenesis in radical orchiectomy specimen and potential implications for patients with testicular cancer

In a cohort of 214 patients with testicular cancer, larger tumors were associated with lower rates of spermatozoa in the cancerous testis. Importantly, 58% of patients with azoospermia and cryptozoospermia had spermatozoa in their histologic sections.

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Authors

Ohad Shoshany, M.D., Yariv Shtabholtz, M.D., Eran Schreter, M.D., Maxim Yakimov, M.D., Haim Pinkas, M.D., Anat Stein, Ph.D., Jack Baniel, M.D., Shay Golan, M.D.

Abstract

Objective

To assess the ability of semen analysis and other patients' characteristics to predict the presence of spermatozoa in radical orchiectomy pathological specimen, and describe potential implications for patients with azoospermia and testis cancer.

Design

Retrospective cohort study.

Setting

Tertiary hospital.

Patient(s)

A total of 214 consecutive patients with testicular cancer who underwent radical orchiectomy between 1997 and 2015.

Intervention(s)

None.

Main Outcome Measure(s)

Histologic slides were reviewed and the presence of mature spermatozoa was documented. Clinical, laboratory, and radiographic characteristics were recorded. Logistic regression analyses were used to identify factors associated with the presence of spermatozoa in the noninvolved ipsilateral testicular parenchyma.

Result(s)

Spermatozoa were found in the pathological specimen of 145 patients (67.8%). At multivariate analysis, increased tumor size was the only factor associated with lower rates of spermatozoa in the specimen. Mean tumor diameter was 4.06 cm, and spermatozoa were found in 83% and 49% of testes with tumor diameters <4 and ≥4 cm, respectively. Preoperative semen analysis records were available for 107 patients. Oligozoospermia, severe oligozoospermia, azoospermia, and cryptozoospermia were observed in 17 (16%), 18 (17%), 9 (8%) and 3 (3%) patients, respectively. Sperm concentration and motility were not associated with complete spermatogenesis. Seven of 12 patients (58%) with either azoospermia or cryptozoospermia had mature sperm in their pathological sections.

Conclusion(s)

Larger testicular cancers are associated with lower rates of spermatozoa in the ipsilateral testis. Given the substantial likelihood (∼60%) of spermatozoa to be present in the cancerous testis of patients with azoospermia and cryptozoospermia, concomitant oncologic testicular sperm extraction (TESE) can be considered in these selected patients.

Read the full text at: http://www.fertstert.org/article/S0015-0282(16)300...

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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