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PubMed2001

Stage I non-seminomatous germ-cell tumours of the testis: identification of a subgroup of patients with a very low risk of relapse.

There is no consensus about a reproducible prognostic model capable of distinguishing between clinical stage I non-seminomatous germ cell tumour (NSGCT) carrying a high and low risk of relapse. The aim of this study was to assess the prognostic value of histological parameters in patients with stage I NSGCT undergoing surveillance after orchiectomy. We retrospectively evaluated tumour specimens from 88 consecutive stage I NSGCT patients undergoing surveillance in our institution between 1984 and 1996. 24 patients relapsed (27%). Multivariate analysis singled out vessel invasion (VI) (relative risk (RR)=3.8; 95% confidence interval (CI) 1.4-10.4) and the presence of mature teratoma (RR= 0.2; 95% CI 0.1-0.6) as independently correlated with relapse-free survival (RFS). Patients can be classified accordingly into three prognostic groups with a low (27 patients with mature teratoma but without VI), intermediate (34 patients with both VI and mature teratoma or with neither VI or mature teratoma) and a high risk (23 patients with VI, but without mature teratoma) of relapse. Relapse rates in these three groups were 0%, 29% (95% CI: 23-35%) and 61% (95% CI: 55-67%), respectively. This prognostic index, based on two standard pathological parameters, identified a subgroup with a very low risk of relapse that represents approximately one third of stage I patients. Patients who belong to this subgroup should be managed by surveillance only, instead of retroperitoneal lymph node dissection (RPLND) or adjuvant chemotherapy.

Adolescent↗
PubMed2000

Adjuvant bleomycin, etoposide and cisplatin in pathological stage II non-seminomatous testicular cancer. the Indiana University experience.

Two cycles of bleomycin, etoposide, and cisplatin (BEP) were evaluated as adjuvant chemotherapy for patients with pathological stage II non-seminomatous germ cell tumours. Between 1985 and 1995, 86 patients with pathological stage II non-seminomatous testicular cancer were treated with two cycles of BEP. At retroperitoneal lymph node dissection (RPLND) 49 patients (57%) had pathological stage II(A) (microscopic nodal metastases) and 37 (43%) had stage II(B) (gross nodal metastases). After RPLND, the patients received bleomycin, 30 units weekly for 8 weeks, etoposide (100 mg/m(2)) and cisplatin (20 mg/m(2)) each for 5 days every 28 days for two cycles as adjuvant chemotherapy. 4 patients were lost to follow-up. 10 patients (12%) developed granulocytopenic fever during their chemotherapy. Of the 82 evaluable patients all remained with no evidence of disease except for a single patient with a cervical nodal relapse of teratoma. This was resected and he remains disease free. Median follow-up has been 85 months (range: 42-173 months). In patients with fully resected stage II non-seminomatous germ cell tumour, two cycles of BEP were almost universally effective in preventing relapse.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Germ cell tumors of the testes: state of the art].

Germ cell tumors of the testes are rare tumors occurring in young men, the incidence of which increases continuously. They are curable in more than 80% of the cases. The treatment of stage I seminoma is lomboaortic radiotherapy, and that of stage I non-seminomatous tumors is either surveillance, retroperitoneal lymph node dissection or adjuvant chemotherapy according to the risk factors of extra-testicular involvement (pure embryonal carcinoma, vascular invasion). For advanced diseases, the standard treatment is three cycles of bleomycin, etoposide, cisplatin (BEP regimen) or four cycles of the same association without bleomycin (EP regimen) and four cycles of the BEP regimen for patients with good risk and poor risk prognostic characteristics, respectively. The five-year overall survival rates are 90% and 50% for patients with good risk and poor risk factors respectively. It is recommended to resect all residual masses after chemotherapy. The standard salvage treatment is four cycles of vinblastin, ifosfamide, cisplatin (VelP regimen). New associations of drugs are under study in order to improve the overall survival rate for the poor-risk and relapsed-tumors patients.

Adult↗
PubMed2001

Delayed orchiectomy after chemotherapy in patients with advanced testicular cancer.

INTRODUCTION: The therapeutic procedures in the management of testicular cancer are determined by histological findings in the removed testis and by the extent of the disease at the time of diagnosis. However, all advanced tumors could be treated by primary chemotherapy regardless of the histological findings. The current imaging techniques (ultrasound of the testis, abdominal and chest CT examination) and laboratory tests (determination of serum tumor markers AFP and hCG) provide sufficient evidence for the presence of cancer. When the diagnosis of advanced tumor is evident, it is possible to start the treatment without orchiectomy. The aim of this study was to evaluate the advantages of neo-adjuvant chemotherapy with delayed orchiectomy in the management of advanced testicular cancer. MATERIAL AND METHODS: A total of 36 patients with advanced germ cell testicular cancer underwent primary PVB or BEP chemotherapy without previous orchiectomy. Mean age of patients was 32 years. Detailed medical, surgical and urological examination showed pulmonary metastases and/or extensive abdominal tumorous masses imitating acute abdominal crisis and impaired drainage of the kidney due to ureteral obstruction. Searching for the origin, testicular tumor was detected. Eleven patients had a bulky disease in the retroperitoneum (Stage IIC), two had enlarged retroperitoneal lymph nodes (Stage IIB), two had enlarged mediastinal lymph nodes (Stage III) and other 16 patients had also pulmonary metastases, and 5 pts had pulmonary metastases only. The patients were treated with cisplatin-containing combination chemotherapy. Following completion of chemotherapy, orchiectomy was performed alone or simultaneously with retroperitoneal lymph node dissection (RPLND) and/or lung metastasectomy in cases with persistent residual mass. Following orchiectomy the patients were regularly checked and in cases with viable malignant tumor found in the testis sequential chemotherapy was administered. Similarly when the relapse of the disease was detected, the patients were treated with sequential chemotherapy. RESULTS: Complete disappearance of metastases was observed in 12 patients following chemotherapy alone. The residual mass persisted in 24 patients (in 22 out of them in the retroperitoneum and in two patients also in the lungs) and was removed surgically. The viable tumor in the removed tissue was found in one patient. Delayed orchiectomy was performed simultaneously with surgical removal of residual mass in the retroperitoneum in 24 patients and as a separate procedure in 12 patients who have been considered to be complete responders following chemotherapy alone. Residual viable tumor in testicular specimen was found in three patients, necrotic or fibrotic tissue in 18, and mature teratoma in 15 patients. Overall survival of the patients was 26/36 (72.7%) at mean of 56.9 months (range 7-145 months, median 50 months) since the start of the treatment. CONCLUSIONS: In patients with advanced germ cell testicular cancer preference must be given to the early beginning of intensive chemotherapy without the need of tissue diagnosis of primary tumor that should be obtained by orchiectomy. Benefit of this therapeutic approach is the timely management of acute abdominal and/or pulmonary symptoms of life-threatening distant metastases.

Adult↗
PubMed2001

Adult primary teratoma of the testis--report on 5 cases in clinical stage I disease.

OBJECTIVES: Testis pure teratoma accounts for 2.7% to 3% of all germ cell tumors in adult where it behaves as a malignant neoplasm. Pure teratoma of the testis presents in clinical stage I disease in 44% of the patients whose risk of having pathological stage II disease is 16.7% to 19.2%. Herein we report on 5 cases of adult pure teratoma of the testis presenting itself in clinical stage I disease. MATERIALS AND METHODS: From September 1976 to February 2000, 75 patients underwent orchidectomy for clinical stage I nonseminomatous germ cell cancer of the testis. Testis pure teratoma was detected in 5 patients (7%). Testis tumor markers were evaluated in all cases. Patients underwent imaging examination to detect the clinical stage of the disease. Treatment options after orchidectomy included retroperitoneal lymph node dissection (RPLND) in 4 patients and surveillance in 1. RESULTS: The average age of the patients was 31 years (range 24-45). The tumor was on the left sided in 3 cases (60%) and right in 2 (40%). Tumor average size was 3.2 cm (rang 1-6). Histopathology detected the following subtypes: mature teratoma in 3 cases (60%), immature teratoma in 1 (20%) and teratoma with malignant transformation in (20%). All patients were at clinical stage I disease. Germ cell cancer microscopic metastatic disease including embryonal carcinoma was detected in I dissected lymph node of 1/4 patients (25%). Average follow up was 166 months (range 93-249). All patients were alive and disease free and no relapses were detected during the follow up period. CONCLUSIONS: Primary pure teratoma of the testis does not respond to chemotherapy nor does it to radiation therapy. The disease treatment options after orchidectomy for patients with clinical stage I disease include RPLND or surveillance with their relative risks and benefits. RPLND is the chosen treatment because it is both staging and treating. A close a long term follow up is required since pure teratoma metastatic disease may clinically develop after more than 10 years.

Adult↗
PubMed1993

Pre- and post-treatment sexual life in testicular cancer patients: a descriptive investigation.

Aspects of sexuality were assessed by questionnaires in 76 testicular cancer patients after orchiectomy before further treatment and, respectively, 6, 12 and 36 months after therapy. Before treatment 11% of the patients reported dissatisfaction with sexual life. About 20% of the patients sometimes experienced reduced libido and erectile difficulties. Six months after therapy significantly more patients (27%) recorded an unsatisfactory sexual life as compared to the pretreatment situation. At the 36 months' evaluation 22 of 76 evaluable patients (18%) still stated that their sexual life was inferior to the pretreatment experience. Libido and erectile function decreased transiently during the first year after treatment in most patients. Twelve patients reported permanent 'dry ejaculation' after bilateral retroperitoneal lymph node dissection. Other sexual disturbances could not be related to specified treatment modalities. Increased age at the time of diagnosis and psychological distress tended to correlate with the incidence of sexual problems. For about 60% of the patients the discussion of expected and experienced sexual life problems was an important issue to be discussed before their treatment for testicular cancer and during follow-up. The high frequency of any kind of long-lasting sexual problems (30%), though often of minor degree, warrants an adequate counselling of these patients before and after treatment.

Adult↗
PubMed1993

Long-term follow-up of pulmonary function in patients cured from testicular cancer with combination chemotherapy including bleomycin.

A follow-up study of pulmonary function in two groups of patients with testicular cancer was performed 6-12 years after treatment. Both groups, 47 patients in each, had undergone retroperitoneal lymph node dissection (RPLND). Patients with pathological stage (ps) II had also received bleomycin (median 270 mg) and cisplatin (median 540 mg) in three or four courses which included vinblastine or etoposide. Patients in ps I and II were similar with respect to age, general health, observation period, inspired oxygen fraction (FiO2) and maximal arterial oxygen pressure (pO2) at RPLND, but four (8.2%) with psII disease developed densities on chest X-ray during chemotherapy. At the long-term follow-up the groups were similar with respect to physical exercise, smoking pattern, present drug treatment and history of cardiopulmonary disease. In both groups forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and single breath transfer factor for carbon monoxide (TLCO) were within normal limits, and no difference was found between the groups. The combined data for both groups showed that smoking was highly associated with impairment in TLCO (P = 0.005), and smoking frequency was negatively correlated to TLCO (P = 0.002). We conclude that 3-4 courses with bleomycin, cisplatin and etoposide/vinblastine in testicular cancer patients do not lead to long-term impairment of pulmonary function.

Adolescent↗
PubMed1994

Sequential resection of residual abdominal and thoracic masses after chemotherapy for metastatic non-seminomatous germ cell tumours.

Thirty-eight patients with advanced non-seminomatous germ cell tumours (NSGCTs) underwent multiple surgical interventions (two in 33 patients, three in four patients, four in one patient) after cisplatin-based chemotherapy. All patients had normal serum tumour markers but persistent radiographic masses. The larger mass was routinely resected first. Fifteen patients (39%) had dissimilar histological findings at sequential surgical procedures, 12 of whom demonstrated less favourable pathological features during the first operation and three at the second. Patients who underwent both retroperitoneal lymph node dissection (RPLND) and lung resection showed less favourable histological features in the retroperitoneum in nine cases and in the lung in three cases. Eight of 16 patients (50%) without mature teratoma in their primary tumours showed complete necrosis/fibrosis at all surgical interventions, whereas all patients whose primary tumour was classified as malignant teratoma intermediate demonstrated mature teratoma at least at one anatomical site. As histology of post-chemotherapy residual masses cannot be extrapolated from one anatomical site to another, patients usually are properly managed by excision of all residual masses. In particular, in patients with necrosis/fibrosis at lung resection omission of RPLND is not advised.

Abdominal Neoplasms↗
PubMed2002

Testicular cancers occurring in brothers with cryptorchism.

We report a case of familial testicular cancer associated with undescended testes in two brothers. The older brother (49 years) presented with a testicular tumor located in the right inguinal canal. The pathologic diagnosis was pure seminoma. Computerized tomography revealed iliac and retroperitoneal lymph node metastases. Four years later, the younger brother (44 years) developed bilateral testicular tumors, one located in the inguinal canal, the other located in the pelvic cavity. The pathologic diagnosis of both tumors was pure seminoma. Radiological examination revealed retroperitoneal lymph node metastases. Both patients received cisplatin-based combination chemotherapy as the initial treatment. The older brother suffered from repeated recurrences with lymph node metastases in the iliac and inguinal regions, but he was successfully treated with high-dose chemotherapy. The younger brother achieved long-term remission after retroperitoneal lymph node dissection following initial chemotherapy. We briefly review the reported cases of familial testicular cancer and discuss the association of the maldescent of the testes and familial testicular cancer cases.

Adult↗
PubMed2002

Elevated serum estradiol suggesting recurrence of Leydig cell tumor nine years after radical orchiectomy.

We report a case of a Leydig cell tumor that showed retroperitoneal lymph node metastasis 9 years after radical orchiectomy. Elevated serum estradiol (E2) suggested recurrence of the Leydig cell tumor. Retroperitoneal lymph node dissection (RPLND) was performed and the lymph node was proved histopathologically to have a metastatic Leydig cell tumor. After RPLND, serum E2 returned to the normal range. This is the first reported case in which changes in the endocrinological findings were useful as likely tumor markers to detect the recurrence of a Leydig cell tumor.

Estradiol↗
PubMed1997

A single-centre observational study of surgery and late malignant events after chemotherapy for germ cell cancer.

OBJECTIVE: To review the impact of surgical staging after treatment on the late malignant events in an unselected group of patients treated with chemotherapy for germ cell cancer of the testis over the last 16 years. PATIENTS AND METHODS: The study comprised 256 patients treated between 1978 and 1994 who were reviewed for late relapse and development of second germ cell and non-germ cell cancer. RESULTS: At diagnosis, 142 patients had clinical stage 2, 30 stage 3 and 84 stage 4 disease; 57 patients relapsed within 20 months of treatment, while late germ-cell cancer relapses (> or = 24 months after treatment) occurred in six patients. Of patients relapsing early or late, 42% and 33%, respectively, received surgery after treatment. Only two of those relapsing late remain progression-free with further treatment. Four patients developed germ cell cancer in the contralateral testis, while six developed second non-germ cell cancers. CONCLUSION: Late events occurred in 6.2% of 256 patients in this series, from 29 to 141 months after treatment. Given that the late relapse rate of six of 256 (2.3%) is less than the incidence of mature teratoma at routine retroperitoneal lymph node dissection, more patients may eventually relapse. These results suggest that there might be a case to evaluate the use of ultrasonographic surveillance of the retroperitoneum and testis at 5, 10 and 20 years, in addition to extending routine surveillance.

Adult↗
PubMed1997

Evaluation of primary standard cisplatin-based chemotherapy for clinical stage II non-seminomatous germ cell tumours of the testis.

OBJECTIVE: To evaluate the use of primary cisplatin-based chemotherapy before retroperitoneal lymph node dissection (RPLND) in patients with clinical stage II non-seminomatous germ cell tumours of the testis. PATIENTS AND METHODS: Between 1984 and 1992, 55 patients with clinical stage II testicular cancer (12 with stage IIA. 33 stage IIB and 10 stage IIC disease) were treated at Institut Gustave Roussy with primary chemotherapy using three conventional regimens including cisplatin. Patients were assessed 4 weeks after the end of chemotherapy and depending on the response, underwent RPLND; the overall survival and disease progression were monitored. RESULTS: Sixteen (29%) patients achieved a sustained complete remission after chemotherapy only, while 30 (55%) patients required subsequent RPLND for persistent residual tumour masses: nine other patients obtained a clinical partial remission. Six patients who initially had achieved either a clinical complete response (three) or a surgical complete response (one) or a clinical partial response (two) subsequently relapsed. Overall, 52 of 55 (95%) patients remained free of disease 33 to 111 months after the end of treatment. CONCLUSION: These results show that primary cisplatin-based chemotherapy can effect a cure of the tumour in all subgroups of patients with stage II disease.

Adolescent↗
PubMed2000

Abdominal relapse in stage 1 nonseminomatous germ cell tumours of the testis managed by surveillance or with adjuvant chemotherapy.

OBJECTIVE: To assess the impact on patterns of recurrence of adjuvant chemotherapy in patients with stage 1 nonseminomatous germ cell tumours (NSGCT) of the testis, who have a high likelihood of relapse on surveillance if certain risk factors are identified in the orchidectomy specimen, and thus the theoretical need for retroperitoneal lymph node dissection (RPLND). PATIENTS AND METHODS: The incidence of abdominal relapse was recorded in 417 men presenting with stage 1 NSGCT over the past 18 years. Up to 1986, 161 men were managed by surveillance alone, and abdominal relapse occurred in 26. From 1986 onwards, men with positive risk factors in the orchidectomy specimen were offered two courses of chemotherapy; 60 accepted and one relapsed in the abdomen, and 196 underwent surveillance and 19 relapsed in the abdomen. RESULTS: Abdominal relapse was significantly reduced from 16% before 1986 to 8% afterward (P = 0.014). Mortality from testicular tumour or treatment toxicity remained low, at 0.6% before 1986 and 2.0% since then. CONCLUSION: The need for RPLND in stage 1 NSGCT remains highly doubtful.

Abdominal Neoplasms↗
PubMed2003

A novel surveillance protocol for stage I nonseminomatous germ cell testicular tumours.

OBJECTIVES: To report the results of a novel surveillance policy for stage I nonseminomatous germ cell tumours (NSGCTs). PATIENTS AND METHODS: Between 1978 and 2000, 132 patients (median age 28 years, range 16-52) who were regularly followed were included in a new surveillance policy. All pathology specimens were studied retrospectively by the same pathologist for embryonal carcinoma, yolk sac tumour and lymphovascular invasion components. A loose surveillance protocol was designed in which computed tomography (CT) was used only for the first year. RESULTS: The median (range) follow-up was 38 (6-265) months; the relapse rate was 24% and all occurred before 23 months, with 87% diagnosed within the first year. Platinum-based chemotherapy was given to patients with relapse, and surgery used after chemotherapy in seven. Among all the risk factors, an embryonal carcinoma component was the only significant predictor of relapse. The overall survival rate was 99%. CONCLUSION: The presence of embryonal carcinoma in the primary pathology is the only risk factor determining the relapse rate of the present surveillance policy for stage I NSGCTs. The overall survival was no different from those reported for retroperitoneal lymph node dissection and primary chemotherapy. Decreasing the frequency of CT in the first year and totally eliminating it after 1 year reduces the cost of surveillance. The possible compliance problems of patients are also minimized, without changing the overall survival. This surveillance protocol for patients with stage I NSGCT has reduced costs and provided a better quality of life for the patients, without jeopardizing the final outcome.

Adolescent↗
PubMed2002

Adjuvant chemotherapy for stage II nonseminomatous germ-cell tumors.

Management options for patients with stage II nonseminomatous germ-cell tumors (NSGCT), completely resected at retroperitoneal lymph node dissection (RPLND), include 2 cycles of adjuvant cisplatin-based chemotherapy, or close surveillance, with chemotherapy reserved for patients who relapse. Both options are associated with cure in an equally high percentage of patients. The decision to choose one of these options over the other is influenced by the extent of the tumor resected and patient compliance. Surveillance is a strong consideration for patients with low-volume nodal disease at RPLND (pN1), because the relapse proportion is 30% or less. In contrast, patients with high-volume nodal involvement at RPLND (pN2) have a relapse rate of 50% to 90% with surveillance alone. Adjuvant chemotherapy is the preferable option in the latter group. A prospective trial of 2 cycles of etoposide plus cisplatin adjuvant chemotherapy for patients with pN2 tumors showed that this regimen was highly effective in achieving relapse-free survival.

Antineoplastic Agents↗
PubMed2002

The role of adjunctive postchemotherapy surgery for nonseminomatous germ-cell tumors: current concepts and controversies.

Adjunctive surgical resection of residual disease after chemotherapy is a critical part of the comprehensive management of patients with advanced nonseminomatous germ-cell tumor (NSGCT). Surgical resection is indicated in the presence of residual radiographic abnormalities and normal serum tumor markers. Necrosis, teratoma, and viable carcinoma can be found at any resected site. After induction chemotherapy, necrosis comprises approximately 50% of histologic findings, teratoma 40%, and viable GCT the remaining 10%. A number of investigators have attempted to predict the presence of necrosis in an effort to obviate surgery. A number of variables predictive of necrosis have been identified and tested prospectively, including: degree of tumor shrinkage, size of pre- and posttreatment mass(es), prechemotherapy markers, and teratomatous components in the orchiectomy specimen. However, the risk for a false-negative prediction remains approximately 20%. The most rigorous approach remains a retroperitoneal lymph node dissection (RPLND). Furthermore, the histologic discordance between different sites ranges from 29% to 46%; thus, all sites of residual disease should be resected. The patient's prognosis is influenced by: (1) completeness of resection, and (2) biology of the tumor (histology of residual mass(es), marker status at the time of RPLND, and prior burden of therapy). Surgical boundaries and completeness of dissection should not be compromised in an attempt to preserve ejaculation.

Combined Modality Therapy↗
PubMed1990

Testicular tumours in infancy and childhood--a review of 10 germ cell tumours and 10 non germ cell tumours.

Between 1961 and 1989 twenty testicular tumours were treated at the Basel University Children's Hospital. Ten were non germ cell tumours (50%) and a further 10 (50%) were germ cell tumours. Of the germ cell tumours six were benign teratomas, two yolk sac tumours and a further two were teratocarcinomas. In the non germ cell group eight tumours originated from paratesticular structures, one of which was a malignant rhabdomyosarcoma. The remaining two neoplasms originated from the supporting testicular tissues. The clinical presentation, the protocol of treatment and the long-term outcome are discussed. We advocate local tumour excision in benign cases (proven by instant frozen section) if normal testicular tissue can be preserved. In malignant germ cell tumours primary orchiectomy and high spermatic cord ligation is the treatment of choice. Secondary chemotherapy and/or retroperitoneal lymph node dissection is only added if the tumour markers alpha-fetoprotein and beta-human chorionic gonadotropin remain present in high serum levels postoperatively. Rhabdomyosarcomas are treated by surgical excision, primary chemotherapy and radiotherapy. All of the five patients (25%) suffering from malignant testicular tumours survived. A long-term follow-up (mean 12 years) did not show any evidence of recurrent local or metastatic disease.

Adolescent↗
PubMed2004

Does brachytherapy of the prostate affect sperm quality and/or fertility in younger men?

OBJECTIVE: Sperm banking prior to surgical procedures which may affect fertility, such as retroperitoneal lymph node dissection, has been well documented. However, such procedures are usually performed in young men. With older men marrying later in life, or remarrying, we wanted to investigate the effects of radiation on prostate cancer patients who wanted to have children afterwards. MATERIAL AND METHODS: We encountered several patients with prostate cancer who decided to undergo brachytherapy and were planning to have more children. We performed a search using PubMed and Ovid for the period 1966-2001 using the key words "fertility", "sperm banking", "radiation effects", "prostate cancer" and "brachytherapy". RESULTS: Of the four young patients we encountered who underwent brachytherapy, we found no significant change in semen parameters post-therapy, and three of them were able to father a child subsequently without any deleterious side-effects. It has been demonstrated in several reports that external-beam radiation therapy is associated with decreased spermatogenesis due to Leydig cell dysfunction and decreased serum testosterone, as well as having a direct effect on spermatogonia. However, there is a scarcity of literature discussing the effects of prostate brachytherapy on spermatogenesis as the patients involved are usually older and usually do not desire to father any more children. As I has a half-life of 60 days, we used an exposure of 10 mR/h at the symphysis pubis and used integration to find the total dose exposed to the testis as follows: Limits 14 400 to 0, S 10e (-In2/1440.Tdt) where T = 14 400 and 20.75 R = 20.75 cGy. Therefore, the total dose was 20.75 cGy x 0.91 = 18.88 cGy. This value is considered too low to have any significant effect on testicular tissues. CONCLUSIONS: We speculate that the effects of prostate brachytherapy on spermatogenesis in prostate cancer patients are minimal. However, due to the half-life of I, we recommend that these patients should wait for at least 3-4 months before trying to conceive. Furthermore, younger men with prostate cancer may want to consider sperm banking prior to brachytherapy if they want to have children in the future.

Adenocarcinoma↗