Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
J Urol. 2016 Jul;196(1):219-24. doi: 10.1016/j.juro.2016.02.2967. Epub 2016 Mar 3.
Fertility preservation options are limited in prepubertal boys with cancer. Worldwide there has been growing interest in testicular tissue cryopreservation as a promising experimental strategy to address future infertility. We measured and compared parent, male cancer survivor and provider willingness to accept the risk of testicular biopsy among prepubertal boys with cancer, and identified reactions to disclosure practices.
We conducted a multicenter study that included 153 parents of prepubertal boys with cancer, 77 male survivors of childhood cancer and 30 oncology providers. The threshold technique was used to measure subject relative willingness to accept risk of testicular biopsy under 4 different aspects of care, ie chance of infertility, complications from biopsy, development of technology to use tissue and tissue storage cost. A total of 47 in-depth interviews were conducted to identify reactions to disclosure practices.
A total of 52 survivors (67%), 22 providers (73%) and 110 parents (72%) selected to have testicular biopsy (vs no biopsy). Median minimum infertility risk to make biopsy worthwhile varied from 25% to 30% among the 3 respondent groups. Interviews revealed that some providers would not offer biopsy in cases of greater perceived risk than benefit, that parents preferred having information regardless of risk of infertility and that nondisclosure elicited adverse feelings from some parents.
Parents, survivors and providers were willing to accept risk of prepubertal testicular biopsy. Parental/survivor desire for information and provider decision not to disclose suggest that barriers to information delivery need to be addressed.
在患有癌症的青春期前男孩中，生育力保存选择有限。全世界对睾丸组织冷冻保存作为解决未来不孕的有前途的实验策略的兴趣日益浓厚。我们测量并比较了患有癌症的青春期前男孩的父母、男性癌症幸存者和提供者对睾丸活检风险的接受意愿，并确定了对披露实践的反应。
我们进行了一项多中心研究，包括 153 名患有癌症的青春期前男孩的父母、77 名儿童癌症幸存者和 30 名肿瘤学提供者。使用阈值技术测量了在 4 个不同的护理方面接受睾丸活检风险的受试者相对意愿，即不孕的机会、活检的并发症、使用组织的技术发展和组织储存成本。共进行了 47 次深入访谈，以确定对披露实践的反应。
共有 52 名幸存者（67%）、22 名提供者（73%）和 110 名父母（72%）选择进行睾丸活检（与不活检相比）。3 组应答者的最小不孕风险中位数从 25%到 30%不等，以使活检有价值。访谈显示，一些提供者在认为风险大于收益的情况下不会提供活检，父母无论不孕风险如何都希望获得信息，而不披露则会引起一些父母的不良情绪。
父母、幸存者和提供者愿意接受青春期前睾丸活检的风险。父母/幸存者对信息的渴望和提供者不披露的决定表明，需要解决信息传递的障碍。
