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Testicular cancer survivorship: Long-term toxicity This article is CUA-accredited
for Section 3 credits of the
and management MOC Program of the RCPSC.
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Noa Shani Shrem ,Lori Wood , Robert J. Hamilton , Kopika Kuhathaas , Piotr Czaykowski ,Matthew Roberts ,
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Andrew Matthew ,Jason P. Izard ,Peter Chung , Lucia Nappi , Jennifer Jones ,Denis Soulières ,
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Armen Aprikian , Nicholas Power , Christina Canil 1
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1 Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie
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University, Halifax, NS, Canada; Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada; Department
of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada; Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada;
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6 Department of Surgical Oncology, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Departments of Urology and Oncology, Queen’s University,
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Kingston, ON, Canada; Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Health Network, University of Toronto, Toronto, ON, Canada; Division of
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Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, Department
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of Psychiatry, University of Toronto, Toronto, ON, Canada; Division of Medical Oncology/Hematology, Le Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada; Division of Urology,
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Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Division of Urology, Department of Surgery, Western University, London, ON, Canada
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Cite as: Shrem NS, Wood L, Hamilton RJ, et al. Testicular cancer survivorship: Long-term toxicity
and management. Can Urol Assoc J 2022;16(8):257-72. http://dx.doi.org/10.5489/cuaj.8009 Table of contents
Introduction........................................................................................257
1..Chemotherapy...............................................................................258
Neurotoxicity.........................................................................258
Introduction Ototoxicity..............................................................................258
Nephrotoxicity.......................................................................259
Lung.toxicity..........................................................................259
Raynaud’s.phenomenon......................................................260
Testicular cancer (TC) occurs most commonly in young men Cognitive.impairment...........................................................260
but, fortunately, is highly curable with surgery, chemotherapy, Cardiovascular.disease,.coronary.artery.disease,.and..
metabolic.syndrome.............................................................261
and/or radiation therapy. Thus, testicular cancer survivors Second.malignant.neoplasms.............................................261
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(TCS) may live for many decades, which increases their risk 2..Radiotherapy....................................................................................262
of developing long-term complications related to their initial Cardiovascular.diseasea......................................................262
cancer diagnosis and treatment. Long-term complications Second.malignant.neoplasms.............................................262
Gastrointestinal.toxicity.......................................................262
may increase mortality and morbidity and decrease qual- 3..Surgery...........................................................................................262
ity of life (QoL) in TCS relative to similar aged men without Retroperitoneal.lymph.node.dissection.............................262
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cancer. Therefore, a delicate balance must be struck between 4..Testosterone.deficiency.and.fertility...........................................263
optimizing cure and minimizing complications. Testosterone.deficiency........................................................263
The goals of this manuscript are to: Fertility....................................................................................263
1. Educate urologists, oncologists, and primary care 5..Psychosocial.issues......................................................................264
Quality.of.life............................................................................264
physicians, as well as TCS, about the potential long- Psychological.distress..........................................................264
term complications of surgery, chemotherapy, and Fatigue....................................................................................265
Sexual.dysfunction.and.body.image..................................265
radiation therapy. Relationships.........................................................................265
2. Make recommendations for monitoring and manag- Return.to.work.......................................................................266
ing these complications. 6..Cancer.recurrence.and.contralateral.testicular.cancer.............266
Unfortunately, for many long-term complications of TC Conclusions..........................................................................................266
treatment, there is limited evidence-based literature and, Summary.table.of.long-term.toxicity.management.and..
therefore, many of our recommendations are based on expert education.for.patients.........................................................................267
opinion and multidisciplinary input. The most important
recommendation to decrease long-term complications is to ment. For guidance on appropriate management, refer to the
ensure that all TC patients are treated appropriately at initial recently published Canadian Urological Association (CUA)
presentation to maximize cure rates and minimize overtreat- testicular germ cell cancer consensus guideline.
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CUAJ • August 2022 • Volume 16, Issue 8 257
© 2022 Canadian Urological Association