Recommendations

Here we present the recommendations for gonadotoxicity surveillance for male childhood, adolescent and young adult cancer survivors.

Impaired spermatogenesis

General recommendation

I Dia1

 

Who needs surveillance?

 I Dia2

What surveillance modality should be used?

 I Dia3

At what frequency and for how long should surveillance be performed?

 I Dia4

When should survivors with impaired spermatogenesis be referred?

I Dia5

Testosterone deficiency

General recommendation

T Dia 1

 

Who needs surveillance?

 T Dia2

What surveillance modality should be used for pre- and peri-pubertal survivorsAt what frequency and for how long?

T Dia3

What surveillance modality should be used for post-pubertal survivorsAt what frequency and for how long?

T Dia4

 

 

When should survivors with abnormalities of pubertal development be referred?

T Dia5

 

 

 

When should post-pubertal survivors with suspected testosterone deficiency be referred?

T Dia6

 

Physical sexual dysfunction

General recommendation

P Dia1

Who needs surveillance?

P Dia2

What surveillance modality should be used?

 P Dia3

When should survivors with suspected physical sexual dysfunction be referred?

P Dia4

 

 

 

 

Treatments with evidence and expert opinion for causing impaired spermatogenesis include cyclophosphamide, chlormethine, procarbazine (level C evidence), busulfan and cyclophosphamide or fludarabine and melphalan for HSCT, ifosfamide, or radiotherapy potentially exposing the testes (supplemental literature search and expert opinion).
At least annually, with increasing frequency as clinically indicated depending on growth and pubertal progress.
Regular growth and pubertal monitoring should be started by no later than 12 years (and no earlier than 10 years) of age. The pubertal increase in growth velocity may be impaired if growth hormone deficiency is also present in survivors who received cranial radiation.
# The absence of initiation of puberty (Tanner stage 2) in boys aged 14 years or older or failure to progress in pubertal stage for 6 months or more.

Green = strong recommendations to do; Yellow = moderate recommendation to do; Orange = weak recommendation to do.

See The Lancet Oncology for the publication.