4 truths about testicular cancer survivorship
By Jessica Saenz and Nicole Brudos Ferrara
Testicular cancer is relatively rare and most frequently affects people ages 20-34, according to the National Cancer Institute. At an age when most people are advancing their careers and education or starting families, a testicular cancer diagnosis can be a significant disruptor.
Fortunately, that disruption is often temporary. "The vast majority of testicular cancers are cured, and patients survive and live a normal life — more than 95% of patients," says Lance Pagliaro, M.D., a Mayo Clinic oncologist.
"That's an important message to get out," says Bradley Leibovich, M.D., a Mayo Clinic urologist. "One thing that prevents people from coming in is the fear of what's going to happen, but most cases of testicular cancer are curable."
This means people diagnosed with testicular cancer need to be well-prepared for survivorship. If you've been diagnosed with the disease, here are four things you should know about life after treatment:
1. Some treatment side effects may be permanent or occur later in life.
The goal of cancer treatment is to achieve a cure and avoid recurrence and the discomfort of additional therapy while minimizing side effects, says Dr. Pagliaro. "We don't want to undertreat and need the patient to return. But we don't want to overtreat and burden that patient with lifelong side effects. Many patients are young people who go on to have a normal life expectancy."
Surgery, chemotherapy and radiation therapy are common treatments for testicular cancer. The first treatment is typically surgery to remove the testicle — a permanent change. It's normal to worry about how your body will look after surgery. If this concerns you, Dr. Leibovich says a prosthetic testicle can be inserted during the procedure.
Chemotherapy and radiation also can cause side effects. "Chemotherapy can be problematic, causing nerve damage to the fingers or the feet, but this is often temporary," says Dr. Pagliaro. "Risks such as hearing loss or sensory neuropathy may be a reasonable tradeoff for curing what would otherwise be a life-threatening disease. We always look carefully at the risks and benefits in the equation."
Some people who undergo testicular cancer treatment may experience side effects years after treatment. These are called late effects. "People treated based on established guidelines wind up having less long-term toxicity and fewer long-term issues from their testicular cancer," says Dr. Leibovich.
Before you begin treatment, discuss the risk of treatment side effects with your healthcare professional.
2. Treatment may affect fertility.
If you’ve been diagnosed with testicular cancer and one day hope to start a family, it's essential to discuss fertility preservation options with your care team before you begin treatment, as surgery, chemotherapy and radiation can all affect testosterone and sperm production.
Dr. Pagliaro says many people diagnosed with testicular cancer can retain reproductive function. "If the remaining testicle is healthy, then a person can have normal reproductive potential," he says.
If this isn’t your situation, your health care professional can help you decide how to preserve your fertility. You may be able to freeze and store sperm for use at a later date through sperm cryopreservation.
"The first thing we do with people interested in preserving fertility is talk about sperm banking," says Dr. Leibovich. "And then we talk about what we can do as we manage their care to maximize their fertility."
3. Treatment rarely affects sexual function.
While cancers in the pelvic area can cause difficulty with sex after treatment, Dr. Leibovich says this is rarely the case with testicular cancer. "Men worry about their testosterone levels — and low testosterone can impact erectile function and sex drive — but most men have normal testosterone levels with just one testicle," he says. "For men that wind up with a lower testosterone level, it can be treated."
If you have specific concerns about sexual function, discuss them with your health care professional and clarify what’s most important to you.
Because testicular cancer is rare, Dr. Leibovich says it’s essential to seek a care team that treats it daily to ensure the best possible outcome. "We find that when inexperienced centers or practitioners try to interpret the right thing to do, small mistakes can negatively impact the likelihood of curing people that should be cured, potentially causing problems later in life."
4. Follow-up care is the final step to ensure a cure and complete recovery.
Testicular cancer survivors require regular follow-up after treatment. "While we expect the majority of people to be cured, we monitor them closely over an extended period to assure that (is the case)," says Dr. Leibovich. "The frequency and the testing varies, but for most men, it’s some combination of blood tests to look for tumor markers, a CT scan of the chest or abdomen and pelvis, and an examination."
The need for additional long-term follow-up after testicular cancer depends on your treatment. "The treatment to cure testicular cancer can increase the likelihood of other cancers later in life, and men that require chemotherapy or radiation therapy have a slightly increased risk of cardiovascular disease," says Dr. Leibovich.
It's normal to feel concerned about testicular cancer recurrence, but it's helpful to remember that the treatment outcome for testicular cancer, even if it recurs, is excellent. And though you may experience fear, anxiety, sadness or even anger, overwhelming emotions should not make daily life or relationships more difficult. If they do, talk to your healthcare professional.
"For many men, it's a psychological issue more than a physical one," says Dr. Leibovich. "They are concerned about the likelihood of cancer returning and having problems later in life. We have experts that can help you cope with all of this."
Join Mayo Clinic Connect, an online community for patients and caregivers, to share experiences, ask questions and find support.
Also, read these articles:
- "Cancer survivors: Late effects of cancer treatment"
- "Fertility preservation: Understand your options before cancer treatment"
- "Q&A on cancer in adolescents and young adults"
- "Emotional recovery after cancer treatment"
- "Lasting physical side effects of cancer"
- "Surviving cancer: What to expect after the diagnosis"
- "7 steps to better nutrition habits for cancer survivors"
- "Cancer and mental health: Coping with the burden of your diagnosis