Of the 155 patients, 17 (11%) underwent orchiectomy alone while the other 89% underwent some form of radiation, chemotherapy or combination of radiation/chemotherapy treatment. At a median follow-up of 10 years (range 5-32 years), no difference was seen the rates of education, employment, marital status and fatherhood between the treatments. Patients who underwent treatment with a combination of chemotherapy and radiation were less likely to be able to maintain an erection (p=0.05) and reported disappointment in their sex life (p=0.03) compared to those who received the other treatments. Exposure to greater than 400 mg/m2 of platinum chemotherapy was also associated with erectile dysfunction (p=0.003) and the ability to achieve an orgasm (p=0.03). Treatment was not associated with sexual anxiety, but combination treatment with chemotherapy and radiation significantly affected the desire to become sexually active. Testosterone levels were not associated with any of the above sexual dysfunction issues, which excludes a hypogonadal diagnosis as likely confounder of the results.
In summary, sexual dysfunction following treatment for germ-cell testicular cancer is more common than expected with approximately 30% of survivors reporting an issue with sexual function or satisfaction. Receipt of combination chemotherapy and radiation was associated with the inability to maintain an erection and overall sexual dissatisfaction. Treatment with high doses of platinum-based chemotherapy (400 mg/m2) was also associated with ED and inability to achieve an orgasm. The authors sadly don’t provide any hypothetical mechanism that could cause this sexual side effects. It is interesting that receipt of chemotherapy was the overall denominator in those suffering from sexual dysfunction which may be related to either neuropathy or possible effects of platinum in the limbic system. While thought-provoking these results will need to be validated in larger cohorts, in the interim, we must at least caution our patients about the possible sexual side effects they could experience following therapy.
Speaker: Michal Chovanec, MD, Ph.D., Department of Oncology, Comenius University, National Cancer Institute, Bratislava, Slovakia
Written by: Andres F. Correa, MD, Fox Chase Cancer Center - Temple Health, at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA