ASCO GU 2018: Current Practice Patterns Surrounding Fertility Concerns in Stage I Seminoma Patients: Survey of United States Radiation Oncologists

San Francisco, CA ( Carl Post and colleagues presented results of their survey of US radiation oncologists with regards to their current practice patterns surrounding fertility concerns for stage I seminoma patients. Indeed, patients with testicular seminoma may face fertility issues because of their underlying disease as well as treatments they undergo. The current patterns of practice among US radiation oncologists aimed at assessing and preserving fertility in patients with stage I seminoma are unknown, thus forming the objective of the current study. The author’s hypothesis was that US radiation oncologists have embraced observation as the first-choice option for stage I seminoma patients.

The authors surveyed practicing US radiation oncologists who are members of ASTRO via an online two-minute, 25 question assessment. Respondents’ characteristics, and perceived patient infertility rates were analyzed for association with treatment recommendations. Among 6,967 surveys, the authors received 353 responses (5.1%), among which 23% consider themselves experts in this disease space. The majority (84%) of respondents recommend observation as a default strategy. Roughly half of radiation oncologists routinely advised fertility assessment for patients prior to observation or chemotherapy, and 74% routinely did so prior to adjuvant radiotherapy. Eighty-three percent of respondents felt that 10-30% of patients are infertile following orchiectomy. When treating patients, 80% routinely use clamshell scrotal shielding. Responders with higher perceived infertility rates were more likely to recommend fertility assessment/sperm banking, and those who routinely advised fertility assessment were more likely to use clamshell shielding during treatment. A limitation of this study is the low survey response rate (5%).

The authors concluded that results of their survey of practicing radiation oncologists in the US revealed a gap in the knowledge of fertility issues in men with stage 1 testicular seminoma and frequency of patient education and fertility counseling. Encouragingly, most radiation oncologists responding to the survey recommend surveillance in the stage I seminoma setting, given that many patients will never relapse and avoid potentially toxic therapy [1].

Presented by: Carl M Post, BS University of Nebraska Medical Center, Omaha, NE

Co-Authors: Aditya Jain, Catherine Degnin, Yiyi Chen, Michael Ellis Craycraft, Arthur Hung, Jerry Jeff Jaboin, Charles R. Thomas, Timur Mitin; University of Nebraska Medical Center, Omaha, NE; Oregon Health & Science University, Portland, OR; Testicular Cancer Society, Cincinnati, OH; Oregon Health and Science University, Portland, OR

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA


1. Nayan M, Jewett MA, Hosni A, et al. Conditional risk of relapse in surveillance for clinical stage I testicular cancer. Eur Urol 2017;71(1):120-127.