Q&A: Testicular Cancer Survivorship

The survivorship stage in a cancer journey does not always signify the end of a cancer experience.

For testicular cancer survivors, it is important to receive long-term, follow-up care after treatment ends.

Long-term, follow-up care helps survivors:

• Monitor for late effects and recurrence
• Cope with physical changes
• Be informed about sexual and reproductive health
• Address psychosocial concerns
• Learn health behaviors that reduce cancer risk
• Develop a comprehensive follow-up care plan
• Be connected to support services
  

At MD Anderson, testicular cancer survivors receive long-term, follow-up care through the Genitourinary Cancer Survivorship Clinic. In addition, the clinic helps those treated at MD Anderson for bladder, prostate, kidney and penile cancer.

William Osai, an advanced practice nurse who oversees the Genitourinary Cancer Survivorship Clinic, answers questions concerning testicular cancer survivorship issues.

All of our survivors have either undergone chemotherapy or radiation, had a testicle removed (orchiectomy) or experienced a combination of these three treatments. After undergoing treatment, such as an orchiectomy, patients' concerns aren't usually about personal appearance, but more about sexual function.

Patients worry about being able to experience a "normal" sex life. Also, fertility is a concern commonly discussed. We offer fertility counseling and information on sperm banking.

Since family history is a risk factor for testicular cancer, patients also worry about the increased risk of their children developing testicular cancer.

After treatment ends, many survivors want their lives to return to the way they were before cancer. Do your patients find that a permanent physical change, like the loss of a testicle, is a constant reminder that their lives are different?

Most patients accept the removal of a testicle as part of their treatment fairly easily. They see it as a necessary step towards beating their cancer.

Causing more of a reminder is hypogonadism. After an orchiectomy, hypogonadism can occur when the remaining sex gland (testicle) produces little or no hormones.

Hypogonadism can cause:

• Impotence
• Loss of sex drive
• Infertility
• Osteoporosis
• Fatigue
• Insulin resistance
• High blood cholesterol and triglycerides
• Weight gain
  

Testosterone replacement therapy typically relieves these effects.  

For many men, testicles are symbolic of manhood and the removal of one can lead to embarrassment or fear about a partner's reaction. Do you find that men are open to asking for help after treatment to address this?

From diagnosis, addressing sexual issues plays an integral part in the planning of treatment. My experience is that most patients are open to discussing sexual issues during and after treatment. Because testicular cancer patients are generally young, body image, sexuality and fertility are important subjects for them.

Physical changes after removal of the testicle can be remedied with prosthesis. However, only a handful of the patients in my clinic have prosthesis. This is mirrored in research data, which shows that only a minority of patients request prosthesis after undergoing an orchiectomy.

Research also shows that orchiectomy patients are more concerned about undressing in public rather than before a sexual partner.

If survivors are interested in counseling or support groups to address their concerns, the clinic serves as a good resource for referrals to MD Anderson support services. We can also give them information on support organizations within their communities.