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

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.
DOI: 10.1016/j.fertnstert.2016.03.012
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

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.

Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

KEYWORDS:
Testis cancer; fertility preservation; onco-TESE; spermatogenesis

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