The Long-Term Effects of Testicular Cancer Treatment
Testicular cancer survivors face a risk of long-term effects and illness—not because of the cancer itself, but because of their treatment. According to a 2009 article in BJU International, up to 25 percent of testicular cancer survivors develop long-term psychological, hearing and circulation problems. They are also twice as likely to develop another cancer.
Before we delve into the long-term effects of testicular cancer treatment, it’s important to understand the main types of treatments, as well as their immediate side effects. The options for treating testicular cancer depend on a number of factors, including the type and stage of cancer and overall health.
Men who are faced with a testicular cancer diagnosis will generally, in consultation with their medical team, have a range of options for treatment. Most common are surgery, radiation therapy and chemotherapy.
The two main types of testicular cancer procedures are surgery to remove the testicle (radical inguinal orchiectomy) and surgery to remove the neighboring lymph nodes (retroperitoneal lymph node dissection).
The short-term risks of surgery include negative reactions to anesthesia, blood clots and infections. Most men experience some pain after surgery, which can be eased with medications.
Radiation therapy makes use of X-rays to destroy cancer cells in the testes. Men who have the type of testicular cancer called seminoma typically get radiation therapy.
Possible side effects of radiation therapy include fatigue, appetite suppression, diarrhea, nausea and skin changes. Most patients regain fertility after radiation therapy, though the time frame varies.
Doctors sometimes use chemotherapy after surgery (and occasionally after radiation) to destroy leftover cancer cells. It can also be used to treat testicular cancer that has spread to other parts of the body. Common side effects of chemotherapy include fatigue, hair loss, nausea, diarrhea, fever, chills, coughing and skin rash.
The reported long-term effects of testicular cancer treatment range from inconvenient to consequential.
Nearly 40 percent of testicular cancer survivors have reported low testosterone levels (hypogonadism), according to a study presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in 2017. Testicular cancer survivors suffering from hypogonadism produce little or no testosterone in the testes.
High blood pressure & high cholesterol
According to results of The Platinum Study, a research project focused on testicular cancer patients and funded by the National Cancer Institute, survivors of testicular cancer who underwent chemotherapy had an increased risk for high blood pressure, hypercholesterolemia (high cholesterol) and obesity. The study, which included 486 testicular cancer survivors, examined the rates of metabolic abnormalities among the survivors who received chemotherapy.
Cisplatin-based chemotherapy has been found to damage the sensory nerves in about 20 percent of patients. About the same percentage of testicular cancer survivors report impaired hearing and tinnitus (ringing in the ears), according to the review in BJU International. Some patients report paresthesia, which is numbness or a burning feeling that generally occurs in the extremities, such as the hands, arms, legs or feet.
A small percentage of recipients of the chemotherapy drug Bleomycin have been found to have lung damage, making lung scarring another potential long-term side effect. Risk factors for lung scarring include being older than 70, smoking, prior injury to the lungs and poor kidney function. It is very rare to have lung damage without these risk factors. Patients who need extra oxygen during surgery might have a higher chance of lung damage because of the drug's effects.
The chemotherapy medication Cisplatin may cause kidney damage, but it has been found to have fewer side effects and be more effective than carboplatin, another common chemotherapy drug. Studies that have examined kidney function years after administering cisplatin have shown low rates of long-term kidney damage, and when this does happen, it is usually minor.
While there is evidence to indicate a majority of testicular cancer survivors adjust well in terms of psychological well-being, long-term emotional problems have been reported in some survivors. The experience of cancer and cancer treatment can affect the psyche and may lead to increased levels of distress. Psychosocial morbidity, which can mean, among other things, anxiety combined with depression, is a psychiatric disorder commonly associated with cancer survivors. Some testicular cancer survivors may experience an increased sense of vulnerability, feelings of inadequacy and symptoms of post-traumatic stress disorder (PTSD).
Risk of developing another cancer
Men who have radiotherapy or chemotherapy for testicular cancer have a slightly increased risk of developing another cancer later in life.
If you are about to undergo treatment for testicular cancer, talk with your doctor about the goals of your treatment plan. Don’t hesitate to ask questions and raise concerns you may have. It’s important to discuss the possible treatment side effects, both short- and long-term issues and what you can do to manage them.
During treatment for testicular cancer, be sure to tell your doctor about all the side effects you have been experiencing. This helps them treat any issues as promptly as possible as well as prevent more serious complications in the future.