Sahin Sergen, Ulus Ismail, Canitez Ibrahim Ogulcan, Yentur Serhat, Temiz Mustafa Zafer, Semercioz Atilla
Bagcilar Research and Training Hospital, Urology Clinic, Istanbul, Türkiye.
Basic Clin Androl. 2025 May 15;35(1):17. doi: 10.1186/s12610-025-00259-0.
Bladder cancer is the sixth most common cancer in males. Bacillus Calmette-Guerin (BCG) immunotherapy, the standard for non-muscle-invasive bladder cancer (NMIBC), effectively reduces recurrence and progression. This study examines the impact of intravesical BCG therapy on semen parameters, focusing on hormonal profiles and sperm quality.
This prospective study included 23 sexually active males diagnosed with NMIBC receiving intravesical BCG therapy. Semen analyses were performed prior to treatment and three months following the induction course. Hormonal profiles, comprising total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL), were evaluated. Patients underwent six weekly instillations of 80 mg/ml SII-ONCO-BCG®, commencing four weeks post-TUR-B surgery. Data from clinical, radiological, and laboratory sources were gathered for analysis. Post-treatment evaluation indicated a significant reduction in sperm concentration, total sperm count, progressive motility, and normal morphology (p < 0.05), alongside a notable increase in the percentage of immotile sperm. LH and PRL levels remained stable despite these changes, while FSH levels exhibited a significant increase (p < 0.05).
BCG therapy adversely affects sperm quality, leading to a marked decrease in sperm concentration, total sperm count, progressive motility, and normal morphology. The findings underscore the potential gonadotoxic effects of BCG, necessitating fertility counseling prior to treatment initiation, especially in younger patients. Semen cryopreservation should be regarded as a preventive strategy. While BCG is considered the gold standard for NMIBC treatment, additional long-term studies are necessary to evaluate the reversibility of its effects and to investigate alternative intravesical therapies that present lower reproductive risks.
膀胱癌是男性中第六大常见癌症。卡介苗（BCG）免疫疗法是非肌肉浸润性膀胱癌（NMIBC）的标准治疗方法，可有效降低复发率和进展风险。本研究探讨膀胱内卡介苗治疗对精液参数的影响，重点关注激素水平和精子质量。
这项前瞻性研究纳入了23名被诊断为NMIBC且接受膀胱内卡介苗治疗的性活跃男性。在治疗前和诱导疗程后三个月进行精液分析。评估了包括总睾酮（TT）、促卵泡激素（FSH）、促黄体生成素（LH）和催乳素（PRL）在内的激素水平。患者在经尿道膀胱肿瘤电切术（TUR-B）手术后四周开始，每周进行一次80mg/ml SII-ONCO-BCG®膀胱灌注，共六次。收集临床、放射学和实验室数据进行分析。治疗后评估显示，精子浓度、总精子数、前向运动能力和正常形态显著降低（p<0.05），同时不动精子百分比显著增加。尽管有这些变化，LH和PRL水平保持稳定，而FSH水平显著升高（p<0.05）。
卡介苗治疗对精子质量有不利影响，导致精子浓度、总精子数、前向运动能力和正常形态显著下降。这些发现强调了卡介苗潜在的性腺毒性作用，在开始治疗前需要进行生育咨询，尤其是对年轻患者。精液冷冻保存应被视为一种预防策略。虽然卡介苗被认为是NMIBC治疗的金标准，但需要更多的长期研究来评估其影响的可逆性，并研究生殖风险较低的替代膀胱内治疗方法。
