Risks from Deferring Treatment for Genitourinary Cancers: A Collaborative Review to Aid Triage and Management During the COVID-19 Pandemic.

Purpose of review To review the evidence regarding a decrease in worldwide sperm parameters and discuss potential causative factors. Recent findings The topic of worldwide decline in sperm parameters is contentious; however, recent high-quality studies have demonstrated that there is indeed a decline in sperm parameters. Several retrospective and basic science studies have shown possible links for this decline in sperm parameters such as obesity, diet, and environmental toxins. Summary There exist substantial data to suggest a decline in sperm counts over time. Although causative factors have yet to be fully elucidated, potential causes include, increased rates of obesity, poor diet, and exposure to environmental toxins. How this decline in sperm counts reflects fertility has yet to be determined. As such, further studies are necessary to evaluate whether this decline in sperm count correlates with decreased fecundity and how to identify and mitigate potential causative factors.

Reasons for worldwide decline in male fertility.

Poly- and perfluoroalkyl substances (PFAS) are manmade synthetic chemicals which have been in existence for over 70 years. Though they are currently being phased out, their persistence in the environment is widespread. There is increasing evidence linking PFAS exposure to health effects, an issue of concern since PFAS such as perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) bioaccumulate in humans, with a half-life of years. Many epidemiological studies suggest that, worldwide, semen quality has decreased over the past several decades. One of the most worrying effects of PFOS and PFOA is their associations with lower testosterone levels, similar to clinical observations in infertile men. This review thus focuses on PFOS/PFOA-associated effects on male reproductive health. The sources of PFAS in drinking water are listed. The current epidemiological studies linking increased exposure to PFAS with lowered testosterone and semen quality, and evidence from rodent studies supporting their function as endocrine disruptors on the reproductive system, exhibiting non-monotonic dose responses, are noted. Finally, their mechanisms of action and possible toxic effects on the Leydig, Sertoli, and germ cells are discussed. Future research efforts must consider utilizing better human model systems for exposure, using more accurate PFAS exposure susceptibility windows, and improvements in statistical modeling of data to account for the endocrine disruptor properties of PFAS.

Perfluoroalkyl Chemicals and Male Reproductive Health: Do PFOA and PFOS Increase Risk for Male Infertility?

Impact of sleep on female and male reproductive functions: a systematic review

为探讨睡眠时间与冠心病、卒中和心血管疾病发病风险间的关系,英国学者对文献做了Meta分析.研究的入选标准为:随访时间＞3年的成年人前瞻性研究;基线时调查了睡眠时间;结局事件包括冠心病、卒中或心血管疾病.最后共纳入了15项研究(24个队列)的474 684名研究对象(随访时间6.9～25.0年).使用随机效应模型合并了入选研究的相对危险度(RR)及其95％置信区间(CI),作者对效应结果进行了评估。

Sleep duration predicts cardiovascular outcomes:a systematic review and meta-analysis of prospective studies

Importance The opportunity to discuss fertility preservation is essential for patients of reproductive age with newly diagnosed cancer before the initiation of treatment. Objective To identify factors associated with fertility preservation counseling among patients of reproductive age before initiating chemotherapy. Design, Setting, and Participants This cross-sectional study used data obtained from the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative, an oncologist-led quality assessment program that surveys approximately 400 oncology practices biannually, from January, 2015, to June, 2019. Main Outcomes and Measures The primary outcome was whether reproductive risks were discussed before initiation of chemotherapy. Multivariate logistic regression was performed to identify factors associated with fertility preservation counseling, controlling for age, sex, race/ethnicity, cancer type, year of study, region, clinic type (academic vs private), annual clinic volume, and rates of insurance coverage. Results Among the 6976 patients of reproductive age (3571 men [51%]; mean (SD) age, 42.5 [7.1] years), with reproductive age ranging from 18 to 40 years for 3405 women and from 18 to 50 years for 3571 men, clinics reported that 3036 of 6976 patients (44%) received counseling regarding the risk of infertility associated with chemotherapy. Women were more likely to be informed (1912 of 3405 [56%]) compared with men (1126 of 3571 [32%]) (P  Conclusions and Relevance The findings suggest that clinicians are more likely to counsel younger patients and female patients about reproductive risks before initiation of chemotherapy. State laws mandating fertility preservation coverage may be associated with improved frequency of fertility counseling before chemotherapy. Further awareness and implementation of ASCO guidelines appear to be needed to improve rates of fertility risk discussion and referrals to fertility specialists before chemotherapy.

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Evaluation of Reported Fertility Preservation Counseling Before Chemotherapy Using the Quality Oncology Practice Initiative Survey.

Testosterone deficiency has been linked to several adverse health outcomes and recent data have suggested that abnormal sleep quality may result in lower testosterone levels We assessed the effect of self-reported sleep patterns on serum testosterone while controlling for co-morbidities, and baseline demographics Using data collected from the 2011–2012 National Health and Nutrition Examination Survey (NHANES), we extracted serum total testosterone level, sleep duration, demographic, and co-morbidities for men aged 16 years and older Univariate and multivariate linear regression was used to estimate the association of number of hours slept, co-morbidities, and demographics with serum testosterone Among the 9756 individuals in the NHANES dataset, 2295 (235%) were males 16 years and older with a median (interquartile range) age of 46 years (29–62) who also had serum testosterone levels drawn Median serum testosterone level was 377 ng/dL (IQR: 279–492 ng/dL) Median number of hours slept was 7 h (IQR: 6–8 h) On multivariate linear regression, we found serum testosterone decreased by 049 ng/dL per year of age (p = 004), 585 ng/dL per hour loss of sleep (p < 001) and 618 ng/dL per unit of body mass index (BMI) increase (p < 001) Among men aged 16–80 in the United States, we found increasing age, impaired sleep and elevated BMI is associated with low testosterone It is important, therefore, that evaluation and treatment of reduced serum testosterone should also include improving sleep duration in combination with weight management

Impaired sleep is associated with low testosterone in US adult males: results from the National Health and Nutrition Examination Survey.

Patient Satisfaction With Telemedicine Appointments in an Academic Andrology-focused Urology Practice During the COVID-19 Pandemic.

Objective To assess the impact of time between prostate cancer diagnosis on biopsy and definitive intervention with radical prostatectomy (RP) in regard to adverse pathologic outcomes using a large multi-surgeon database. Materials and methods We retrospectively reviewed 2,728 patients who underwent RP between 2005 and 2014. Patients were stratified according to biopsy Grade Group (GG). Pathologic outcomes were evaluated for patients with <2 months between biopsy and surgery and then at monthly intervals of up to 6 months. Adverse pathological outcomes were defined as Gleason upgrading from biopsy, the presence of extraprostatic extension (EPE, pT3a) or seminal vesicle invasion (SVI, pT3b), positive surgical margins, and lymph node positivity. The chi-squared test was used for statistical analysis. Results In total 2,310 patients met the inclusion criteria. Median time from biopsy to surgery was 83 days (range: 61-109 days). No difference was observed for patients in any risk category regarding the adverse pathologic outcomes, including GG upgrade from biopsy to prostatectomy, presence of EPE, SVI, positive surgical margins, and positive lymph node involvement, with delays of up to 6 months between biopsy and RP. Surgical margins were positive in 25% of cases with pT2 disease and 50.2% of cases with pT3 and greater disease. EPE and SVI were present in 24.5% and 7.5% of specimens, respectively. Conclusion Surgical delays of up to 6 months following prostate biopsy were not associated with an increased risk of GG upgrading, EPE, SVI, positive surgical margins, or lymph node involvement.

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Benjamin Shiff

Papers

Reasons for worldwide decline in male fertility.

Evaluation of Reported Fertility Preservation Counseling Before Chemotherapy Using the Quality Oncology Practice Initiative Survey.

Impaired sleep is associated with low testosterone in US adult males: results from the National Health and Nutrition Examination Survey.

Patient Satisfaction With Telemedicine Appointments in an Academic Andrology-focused Urology Practice During the COVID-19 Pandemic.

The effect of time from biopsy to radical prostatectomy on adverse pathologic outcomes.