Dear OncoLink "Ask the Experts,"
One of my best friends has been diagnosed with seminoma. It has been two weeks since his orchiectomy. For some reason, he has not had radiation therapy (RT) yet. His seminoma is still in Stage I according to his doctor's opinion.
I would like to know when the RT should be done after removal of the testicle in a normal case and how long the RT can be postponed?
Another question is how long will it take him to recover his sperm count after RT?
These questions are very important for us to make the decision on the next step of treatment. Could you give me some idea as soon as possible? Thank you very much for your help!
I am looking forward to hearing from you!
Li Liu, MD OncoLink Editorial Assistant, responds:
Thank you for your interest and question.
The standard treatment of patients with stage I seminoma is post-orchiectomy irradiation. The cure rate for this treatment approaches 99%. Radiation treatments usually start 3-5 weeks after orchiectomy (testicle removal). With improvement of staging techniques, such as CT scan and MRI scan, and availability of highly effective radiation therapy and chemotherapy, some investigators have examined the possibility of post-orchiectomy surveillance only. In this model, radiotherapy and/or chemotherapy would be used for "salvage therapy" should the patient relapse.
Three major series of surveillance have been reported from Toronto, Royal Marsden Hospital and Danish Cooperative Group (Thomas, GM: Surveillance in Stage I seminoma of the testis. Urology Clinic of North American. 1993; 20:85). The incidence of relapses ranged from 13 to 18%, with a median follow-up of 30 to 48 months. The ultimate survival ranged from 99.5 to 100%. One has to keep in mind that since this is a highly curable disease, surveillance should only be used as a treatment option for compliant patients. They should be monitored for a minimal span of 10 years.
Approximately 50% of patients with testicular seminoma have some degree of spermatogenic (sperm production) impairment even prior to the treatment. This has made the evaluation of radiation-induced spermatogenic impairment difficult. Careful shielding of the remaining testis during radiation treatment should be used if the patient wishes to preserve fertility. Most radiation oncologists will advise delaying attempts at conception until 6 to 12 months following completion of radiation therapy. Many medical centers are now offering "sperm banking" before radiation treatment and/or chemotherapy.
I would strongly recommend your friend to talk to his doctors about these options before he undergoes any definitive therapy.
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