To assess the impact of ejaculatory dysfunction (EjD; failure of emission or retrograde ejaculation) on health-related quality of life (HRQoL) after retroperitoneal lymph node dissection (RPLND) for testicular cancer and explore the efficacy of pseudoephedrine hydrochloride as treatment.
In a single arm, phase II trial, patients at ≥6 months after RPLND were invited to complete patient-reported outcome measures (European Organisation for Research and Treatment of Cancer [EORTC] quality of life questionnaire [QLQ]-30-item core, EORTC QLQ-testicular cancer-26, and Brief Male Sexual Function Inventory) evaluating HRQoL and sexual function in follow-up (ACTRN12622000537752/12622000542796). If EjD was reported, post-ejaculatory urine ± semen analysis was undertaken. In eligible patients, pseudoephedrine hydrochloride 60 mg was administered orally every 6 h for six doses. The primary endpoint was sperm count >39 million sperm/ejaculate (>5th centile) following treatment. The trial was powered to detect a clinically relevant 36% achieving sperm count of >39 million sperm/ejaculate. Secondary endpoints included semen volume >1.5 mL, total motile sperm count, safety, and HRQoL impacts.
Of the 58 patients enrolled, the median (interquartile range [IQR]) age was 35 (29-41) years, with a median (IQR) of 37 (18-60) months from RPLND. EjD was reported in 33 (57%), including 27/52 (52%) receiving follow-up at our centre. There were no differences in global HRQoL; however, role functioning (P = 0.045), sexual problems (P < 0.005), and sexual enjoyment (P = 0.005) was poorer if EjD was present. In all, 24/33 (73%) patients with EjD consented to pseudoephedrine treatment. Of 22 evaluable patients, four (18%) achieved a sperm count of >39 million/ejaculate (P = 0.20), and four (18%) had a semen volume of >1.5 mL (P = 0.20). There was a mean increase of 105 million sperm/ejaculate (P = 0.051) and 1.47 mL increase in semen volume (P = 0.01). No safety concerns arose.
Ejaculatory dysfunction is common after RPLND but did not impact global HRQoL in our cohort. Pseudoephedrine improved EjD for some; however, its efficacy was lower than expected. Pseudoephedrine may be considered on an individualised basis.
BJU international. 2024 Jul 23 [Epub ahead of print]
Ciara Conduit, Jeremy Lewin, Wei Hong, Ie-Wen Sim, Gulfam Ahmad, Matt Leonard, Sophie O'Haire, Mary Moody, Amanda D Hutchinson, Nathan Lawrentschuk, Benjamin Thomas, Haryana M Dhillon, Ben Tran
Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia., Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia., Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia., Andrology, Royal Children's Hospital, Melbourne, Victoria, Australia., The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Sydney, New South Wales, Australia., Justice and Society, Behaviour-Brain-Body Research Centre, University of South Australia, Adelaide, South Australia, Australia., Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia., Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia., Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia.