Testicular Cancer Survivors

For patients who receive a diagnosis when the tumor remains confined to a single testicle — and most patients do — the long-term effects of the disease tend to be minimal. Recurrence is rare, and the lifetime risk of a new cancer in the second testicle is 2 to 5 percent. Most of those patients always retain a single working testicle, which in many cases can produce enough testosterone and sperm to keep them healthy and fertile for many years.

Metabolic side effects combine with the cardio­vascular side effects to increase the risk of a range of problems, including hypertension, stroke, heart attacks, hyperlipidemia and obesity. “It is very important for testicular cancer survivors, especially those who underwent chemotherapy, to always continue making regular visits to an oncologist and/or a primary care provider who understands testicular cancer survivorship issues. They do not have the luxury of letting medical care slide a bit while they’re still young, because they are starting off with a potentially serious cardio­vascular risk factor,” says David J. Vaughn, M.D., vice chief for clinical affairs in the hematology/oncology department at Penn Medicine in Philadelphia. Testicular cancer survivors who receive chemotherapy without experiencing immediate lung damage tend to maintain normal cardiovascular health in the years just after treatment, but they face an elevated risk of serious problems decades later. Compared with men who have not had this type of cancer, they are more likely to develop not just hypertension but also high cholesterol and diabetes.

ESMO’s political initiatives aim to promote the profession of medical oncology and keep cancer policy high on the European healthcare agenda. Invest in your future and the future of cancer care. Learn more about our Oncology Fellowship Programme. Posttraumatic growth (243) in cancer survivors is an area of research that focuses on personal development, interpersonal relationships, and spiritual and/or existential experiences (244).

Late recurrences are histopathologically similar to the early relapses but are biologically different (47). For example, there is a relative lack of efficacy of chemotherapy alone in this setting and a generally poor prognosis.

This gives a more accurate picture of cancer survival. You can read more statistics on survival rates and other factors for testicular cancer in our Cancer Statistics section. There are two categories of outlook for pure seminoma testicular cancer – good prognosis and intermediate prognosis. No one with pure seminoma is classified as having a poor prognosis. Around 80 out of 100 men (around 80%) survive their cancer for 5 years or more after diagnosis.

“Testicular cancer survivors whose treatment included chemotherapy, radiation therapy, or both have an increased risk of dying from cardiovascular disease. This study provides valuable information as we try to understand why. It also serves as an important reminder for appropriate long-term health care after completing cancer treatment, as detailed in the NCCN Guidelines for Survivorship,” said Dr. Gilligan. In patients who have normal serum levels of human chorionic gonadotropin, orchiectomy may lead to increased follicle-stimulating hormone and decreased inhibin B levels, whereas the level of serum testosterone is generally unaffected by this surgical procedure (115).

Testicular cancer most often begins with changes in the germ cells. These are the cells in your testicles that produce sperm.

It is important to remember that statistics on the survival rates for men with testicular cancer are an estimate. The estimate comes from annual data based on the number of men with this cancer in the United States. Also, 5-year survival estimates are based on information that is at least 5 years old.

They don't provide information about the type of testicular cancer or tumour marker level. Apr 2, 2015 Several times a year, Mark Klein visits high schools in the Toledo, Ohio area to share his story with groups of junior and senior boys. He tells them about the symptoms that led him to seek treatment and what it’s been like for him to survive testicular cancer. ADVERTISEMENT They were looking to do a segment on men with testicular cancer. Then the Testicular Cancer Society reached out to me.

Testicular cancer is the most curable solid tumor, with an overall 10-year relative survival rate of more than 95% (1,2). Given the young average age at diagnosis, it is estimated that successful treatment approaches, in particular, platinum-based chemotherapy (3–5), have resulted in an average gain of several decades of life for patients with advanced disease. The high cure rate of patients with testicular cancer, however, is offset by the emergence of considerable long-term morbidity (6–8). The late effects of testicular cancer and its treatment include second malignant neoplasms, cardiovascular disease, neurotoxicity, nephrotoxicity, pulmonary toxicity, hypogonadism, decreased fertility, psychosocial disorders, and possibly cognitive impairment (3–8).

After additional treatment, serum testosterone levels in testicular cancer survivors are typically found to be at the lower spectrum of the normal range (116,117), with 12%–16% of long-term survivors classified as hypogonadal by laboratory standards (116,118). The clinical significance of low-grade hypogonadism among testicular cancer survivors is not well studied, although in other settings, a decreased level of serum testosterone contributes to the development of osteoporosis, metabolic syndrome, type 2 diabetes, decreased quality of life, premature aging, and cardiovascular disease (119). There are few data, however, on skeletal health among testicular cancer survivors (120,121).

He was happy to tell us his story — and urge men to speak up when concerns arise. THE RESEARCHERS encourage providers to screen and adequately treat testicular cancer survivors for hypertension, dyslipidemia, and hypogonadism and to advocate for the adoption of healthy lifestyle practices like regular exercise and tobacco avoidance. They also recommend that young testicular cancer survivors discuss the risks and benefits of testosterone replacement therapy with their physicians. “For testicular cancer survivors, as with most cancer survivors, the medical concerns don’t end with remission,” explained Timothy Gilligan, MD, MS, Vice Chair for Education and Associate Professor of Medicine, Case Comprehensive Cancer Center/ University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute.

The prevalence of infertility-related distress in spouses of testicular cancer survivors has not been examined since 1987 (237). An increasing body of literature links oxidative damage and antioxidant enzyme activity to cardiovascular disease (201–204), selected types of cancer (201,205–207), and other diseases (201) and to survival after a cancer diagnosis (208). Thus, genes in oxidative stress response pathways that play a role in DNA repair after radiotherapy and chemotherapy should be investigated, including genes for myeloperoxidase, catalase, nitric oxide synthase, heme oxygenase, and manganese superoxide dismutase (208–210). For future research directions in hypogonadism and decreased fertility, a longitudinal cohort study that addresses the incidence, course, and clinical significance of subclinical hypogonadism among testicular cancer survivors is recommended.

Dr. Gilligan chairs the National Comprehensive Cancer Network® (NCCN®) Guidelines Panel on Testicular Cancer. My wife was pregnant with our first child when I realized that my chronic back pain was worrisome.

It is not clear whether testicular cancer survivors experience more depressive disorders than the general population because a statistically significantly increased prevalence has been reported in some studies (74) but not in others (230). Although the Hodgkin lymphoma-breast cancer risk model included only treatment variables (216), Wu et al. (147) recently showed that the prediction of second malignant neoplasms or recurrence in patients with early-stage head and neck squamous cell carcinoma was statistically significantly improved by the incorporation of genetic data into statistical models. Such a combined approach could also be considered in risk prediction of second malignant neoplasms in testicular cancer survivors. For future research directions in nephrotoxicity, comprehensive assessments of renal function at more than 10 years after treatment should be undertaken in large studies of testicular cancer survivors.

Type and cumulative amount of cytotoxic drugs and radiotherapy play important roles in the development of therapy-induced late effects (22), as do comorbidities and stressor conditions (138). In recent years, testing for polymorphic variation in various loci has proven useful to assess genetic susceptibility to the late effects of cancer treatment, although little information is specifically available for testicular cancer survivors (available information is summarized in Table 1 ). However, data gleaned from studies of patients with other cancers have aided our understanding of the genetic contribution to late complications, as have findings from cell and animal model systems. In general, inheritance of several rare genetic variants in DNA repair and cell cycle responsive genes predispose to radiation-induced sensitivity (145) and to second malignant neoplasms (146) with relatively high penetrance. However, for most cancer survivors, the occurrence of late sequelae reflects a polygenic trait, with cumulative risk determined by multiple, low- or intermediate-penetrance, common risk alleles at different loci (147).

To our knowledge, no studies in this area have been undertaken in testicular cancer survivors. Consideration should also be given to the investigation of interactions between treatment for testicular cancer and genes identified in the general population as relevant to cognitive function (211–212), depression (213), fatigue (214), and other areas relevant to cancer survivorship (see below).

My doctor ordered an X-ray, which revealed a mass on my abdomen that looked like cancer. My world seemed to slow down.

I learned through that how much I can impact people and how just sharing your story helps other people know that there are people out there that have gone through this too. Sharing and being vocal about your health concerns, as a man, is an important thing to do, because most men internalize it.

The results of a few studies suggest a tiny increased risk of birth defects when men conceive very shortly after completing chemotherapy, Feldman said, but no evidence of problems beyond the one-year mark. By the time he noticed the lump on his testicle, the cancer had spread to his lymph nodes, his abdomen and the area behind his kidneys. He lost his left testicle to cancer, banked some sperm at the local fertility clinic and began the combination chemo­therapy that would, hopefully, cure him — but would also elevate his lifetime risk of everything from stroke to hearing loss. In very advanced cases of testicular cancer, high-dose chemotherapy may be followed by a stem cell transplant. Once the chemotherapy has destroyed the cancer cells, the stem cells are administered and develop into healthy blood cells.

Neither investigation found an elevated risk of objectively assessed cognitive difficulties, although subjective complaints were common. To our knowledge, infertility-related distress has not been studied since 1990, when Rieker et al. (236) found that the ability to have children is highly valued by testicular cancer survivors.

Potent therapeutic exposures may amplify the role of genetic factors in the development of late effects, as shown for treatment-induced leukemia (185). Genome-wide association studies for drug response have identified several intermediate and/or large effect variants (186,187) that have the potential to be developed in the clinic as genetic screening tools. Spermatogenesis after treatment for testicular cancer is largely dependent on gonadal function before treatment, patient age, and type of therapy (115, 122–128).

In the second year it was every other month. In the third, it was every quarter of a year and so on until you hit five years. After that you’re given a clean bill of health and you can move on with your life.

Whether this molecular difference could be therapeutically exploited, if validated, should be the subject of future research. For future research directions in second malignant neoplasms, it will be important to determine whether the reduction in radiation field sizes and doses that were introduced in the 1990s (49,50), along with the use of carboplatin as adjuvant therapy in seminoma patients (51), will be accompanied by a decrease in the risk of second malignant neoplasm. The long-term effect of cisplatin-based chemotherapy on the site-specific risk of solid tumors, associated temporal patterns, and the influence of age at exposure and attained age should also be examined in analytic studies that control for lifestyle influences, shared etiologic factors, and host determinants (17,52). Screening strategies for selected second malignant neoplasms should be considered.

Most testis cancer patients can have children because usually the opposite testicle makes a normal amount of sperm. That Friday, I had surgery to remove my testicle.

Klein attended his first event, the Relay For Life of Oregon, Ohio, 6 months after his diagnosis. A friend pushed him around the survivors’ lap in a wheelchair. The second time he attended, he walked the lap. But his favorite activity at the event was hitting a car with a sledgehammer.

We review research priorities identified during an international workshop devoted to testicular cancer survivors. Recommendations include 1) institution of lifelong follow-up of testicular cancer survivors within a large cohort setting to ascertain risks of emerging toxicities and the evolution of known late sequelae, 2) development of comprehensive risk prediction models that include treatment factors and genetic modifiers of late sequelae, 3) elucidation of the effect(s) of decades-long exposure to low serum levels of platinum, 4) assessment of the overall burden of medical and psychosocial morbidity, and 5) the eventual formulation of evidence-based long-term follow-up guidelines and interventions. Just as testicular cancer once served as the paradigm of a curable malignancy, comprehensive follow-up studies of testicular cancer survivors can pioneer new methodologies in survivorship research for all adult-onset cancer.

4. Most men diagnosed with testicular cancer can still have children. Men diagnosed with testicular cancer need surgery to remove the affected testicle. This removes the cancer and allows us to find out if you need simple surveillance, radiation or chemotherapy. You only need one testicle to produce sperm and the male sex hormone testosterone, and only 1 to 2 percent of men with testis cancer get it in both testicles.

If your doctor suspects cancer, your entire testicle may need to be removed to obtain a tissue sample. This can’t be done when your testicle is still in the scrotum because doing so can cause cancer to spread through the scrotum. Nonseminomas are the more common form of testicular cancer. This type is faster growing and may spread to other parts of your body.

Data with regard to the effect of various levels of gonadal dysfunction on cardiovascular disease, premature aging, fatigue, osteoporosis, mental health, quality of life, and sexuality should be collected. The acute nephrotoxic effects of cisplatin-based therapy have been well described (97–111). Most testicular cancer survivors who were treated with cisplatin-based therapy experienced an acute reversible decrease in the glomerular filtration rate but some sustain irreversible damage (106–109).

For men with cancer that has not spread beyond the testicles (Stage 1; see Stages), the survival rate is 99%. Approximately 68% of men are diagnosed at this stage. For unknown reasons, the number of testicular cancer cases has increased for the past 40 years. However, the rate of increase has slowed down recently.

No UK-wide survival statistics are available for testicular cancer that has spread. The survival statistics below are from a large international study. Researchers and doctors have use a system for trying to predict the outcome for men with testicular cancer that has spread. Men's outlook is defined as having good prognosis, intermediate prognosis or poor prognosis. The figures below are for 4 stages of testicular cancer.

The analyses’ results show that there is no significative difference between healthy controls and TCSs health-related QoL. There is a drop of QoL in the phases of diagnosis and treatment, but later it returns on controls level.

Learn more about understanding statistics. For men with cancer that has spread to the lymph nodes in the back of the abdomen, called the retroperitoneal lymph nodes, the survival rate is about 96%. But, this depends on the size of the lymph nodes with cancer. For men with cancer that has spread outside the testicles to areas beyond the retroperitoneal lymph nodes, such as to the lungs or other organs, the survival rate is 74%.

It’s a systemic treatment, which means it can kill cancer cells that have traveled to other parts of your body. When it’s taken orally or through the veins, it can travel through your bloodstream to kill cancer cells. Once the diagnosis has been made, tests such as pelvic and abdominal CT scans will be done to see if the cancer has spread anywhere else. This is called staging. According to the American Cancer Society, for those with testicular cancer in early stages, the five-year survival rate is greater than 95 percent.

More than 80 out of 100 men (more than 80%) survive their cancer for 5 years or more after diagnosis. Almost 95 out of 100 men (almost 95%) survive their cancer for 5 years or more after diagnosis. Almost all men survive their cancer for five years or more after diagnosis. Doctors collect statistical information about different types of cancer and outlook. The outlook is the likely outcome of your cancer and treatment.