Testicular cancer and the problems of male hypogonadism and infertility are closely related to each other—from a clinical as well as a biological point of view. Thus, men previously treated for testicular cancer are more and more frequently seen among patients referred to infertility clinics. This is due to the fact that:
◆ the survival rate among young testicular cancer patients is very high, being close to 95%, and the quality of life—including gonadal function—plays an important role in the men who have been cured
◆ there is an increasing knowledge that testicular function—both spermatogenesis and androgen production—in men with germ cell cancer is severely impaired. Recent research indicates a common prenatal cause of these pathologies of reproductive system
◆ modern techniques of assisted reproduction, particularly intracytoplasmic sperm injection (ICSI), have made it possible to obtain fertilization even when using ejaculates of extremely poor quality. This option has improved the possibility of cancer treated men becoming fathers. However, a source of potential worry is possible sperm DNA damage related to cancer and its treatment
◆ testicular germ cell cancer is more common in men presenting with poor semen quality. Thus, when investigating a man for infertility he should be assessed as to whether he belongs to a high-risk group for which a proper screening procedure should be offered (see below)
Apart from this clinical link between testicular cancer and male infertility, there are also some indications of common biological factors involved in aetiology and pathogenesis. In this chapter some basic biological aspects of testicular cancer will be described. In Chapter 9.5.1 the hypothesis linking a rise of gonadal malignancy and poor testicular function is explained in more detail.
Irinotecan in patients with relapsed or cisplatin-refractory germ cell cancer: a phase II study of the German Testicular Cancer Study Group
