{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T15:03:30Z","timestamp":1791644610245,"version":"4.3.4"},"reference-count":28,"publisher":"Wiley","issue":"22","license":[{"start":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T00:00:00Z","timestamp":1691452800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010128","name":"Lasten Sy\u00f6p\u00e4s\u00e4\u00e4ti\u00f6 V\u00e4reen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010128","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2023,11,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Childhood cancer therapy may cause long\u2010term effects. This cross\u2010sectional study evaluated adulthood milestones in male childhood cancer survivors (CCS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study population comprised 252 male CCS with 6 to 42\u00a0years of survival diagnosed at the Children\u2019s Hospital in Helsinki (1964\u20132000) at the age of 0 to 17\u00a0years. Sex\u2010, age\u2010, and area of residence\u2013matched population controls were randomly selected from the Finnish national registries. Data on moving away from the parental home, marital status, offspring, and adoption in CCS were compared with the population controls. We analyzed the influence of chemotherapy and radiation exposures and testicular dysfunction (ever nontestosterone\u2010substituted serum follicle stimulating hormone\u00a0&gt;15\u2009IU\/L, luteinizing hormone &gt;15\u2009IU\/L, testosterone &lt;2\u00a0ng\/mL (5\u00a0nmol\/L), need of testosterone replacement therapy, or testicular volume &lt;12\u00a0mL at the end of puberty) during pubertal maturation on long\u2010term social outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CCS moved away from their parental home as frequently as population controls (97.8% vs. 98.5%, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.45). CCS were less likely to marry or live in a registered relationship (46.4% vs. 57.5%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001), especially when diagnosed at a young age (&lt;4\u00a0years). Among those married, the probability of divorce was similar between CCS and population controls (27.4% vs. 23.8%, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.41). Survivors were less likely to sire a child (38.5% vs. 59.1%, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001) and more likely to adopt (2% vs. 0.4%, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.015). Lower probability of paternity was associated with hematopoietic stem cell therapy, testicular radiation dose &gt;6\u00a0Gy, pubertal signs of testicular dysfunction (nontestosterone\u2010substituted serum follicle stimulating hormone\u00a0&gt;15\u2009IU\/L, luteinizing hormone \u00a0&gt;15\u2009IU\/L, testosterone &lt;2\u00a0ng\/mL (5\u00a0nmol\/L), or need of testosterone replacement therapy during puberty, or testicular volume &lt;12\u00a0mL at the end of puberty) or azoospermia after puberty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study emphasizes the value of pubertal monitoring of testicular function to estimate future probability of paternity. If no signs of dysfunction occurred during pubertal follow\u2010up, paternity was comparable to population controls. Testicular radiation dose &gt;6\u00a0Gy appeared to be the strongest risk factor for decreased paternity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Plain Language Summary<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Treatment with intensive therapies, including hematopoietic stem cell therapy, testicular radiation dose &gt;6\u00a0Gy, and signs of testicular dysfunction, during puberty are important risk factors for lower rates of fertility.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Intensive therapies and testicular dysfunction itself do not similarly hamper psychosocial milestones in adulthood; cancer diagnosis at a very young age (&lt;4\u00a0years) lower the probability of marriage.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>This study accentuates the importance of monitoring of pubertal development, emphasizing on testicular function, not only sperm analysis, to estimate future fertility among male childhood cancer survivors.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.34971","type":"journal-article","created":{"date-parts":[[2023,8,8]],"date-time":"2023-08-08T09:43:22Z","timestamp":1691487802000},"page":"3633-3644","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Therapeutic exposures and pubertal testicular dysfunction are associated with adulthood milestones and paternity after childhood cancer"],"prefix":"10.1002","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0773-4125","authenticated-orcid":false,"given":"Melanie","family":"Korhonen","sequence":"first","affiliation":[{"name":"Children's Hospital University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juuso","family":"Tainio","sequence":"additional","affiliation":[{"name":"Children's Hospital University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikael","family":"Koskela","sequence":"additional","affiliation":[{"name":"Children's Hospital University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura\u2010Maria","family":"Madanat\u2010Harjuoja","sequence":"additional","affiliation":[{"name":"Children's Hospital University of Helsinki and Helsinki University Hospital  Helsinki Finland"},{"name":"Finnish Cancer Registry  Helsinki Finland"},{"name":"Dana\u2010Farber Cancer Institute\/Boston Children\u2019s Cancer and Blood Disorders Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsi","family":"Jahnukainen","sequence":"additional","affiliation":[{"name":"Children's Hospital University of Helsinki and Helsinki University Hospital  Helsinki Finland"},{"name":"NORDFERTIL Research Lab Stockholm Karolinska Institute and University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.21.1425"},{"key":"e_1_2_9_3_1","unstructured":"Late effects of cancer and cancer treatment.Reviewed by: Joanne Quillen MSN PNP BC Oncology (Cancer Care) at Nemours Children's Health. 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