PRETREATMENT DNA-PLOIDY OF SPERM CELLS AS A PREDICTIVE PARAMETER OF POSTTREATMENT SPERMATOGENESIS IN PATIENTS WITH TESTICULAR CANCER

Objective To evaluate DNA now cytometry (DNA FCM) as a means of predicting post-treatment spermatogenesis in patients with testicular cancer. Subjects and methods After unilateral orchidectomy and before further treatment (pre-treatment), light microscopic sperm cell analysis and FCM were performed in 96 patients in whom post-treatment sperm cell counts were available greater than or equal to 2 years after therapy. Twenty-nine patients had not received any cytotoxic treatment after orchidectomy, whereas 64 had received either abdominal radiotherapy [37] or 3-4 cycles of cisplatin based chemotherapy [27]. Three patients had both chemotherapy and radiotherapy. A control group consisted of 26 healthy age-matched men. Results In the pre-treatment situation 43% of the patients had low sperm counts (<10 x 10(6)/ml). A median of 38 months after treatment the median sperm cell density had increased significantly, independent of treatment, but was still less than that of the control group. All control specimens, but only 66% of the patients' ejaculates, contained cells of which more than 90% were classified as being condensed DNA haploid sperm cells. The median percentages of cells classified as non-condensed DNA haploid, as DNA diploid or as being above DNA diploid cells were increased in the patients' samples as compared with those of the controls, both before and after treatment. Conclusion Spermatogenesis is quantitatively and qualitatively impaired in patients with newly diagnosed testicular cancer. Long-term recovery is relatively independent of routine treatment but is related to the pre-treatment sperm cell density. For the whole series of patients DNA FCM parameters did not yield independent parameters which predicted recovery of spermatogenesis. In patients in whom no sperm cells were found by light microscopy of the seminal fluid the demonstration of greater than or equal to 30% condensed DNA haploid cells was correlated with post-treatment recovery of spermatogenesis.