Testicular Cancer

Follow-up

What happens after treatment?

Follow-up

Your doctor will schedule you for regular visits after treatment to see if the cancer has come back (recurrence). Visits may include a physical examination, blood tests, chest x-ray, and/or a CT scan to look for new tumours. Visits are usually more frequent just after treatment ends. Follow-up typically continues for at least 5 years.

If there is no recurrence, you do not need further treatment.

Treatment of recurrence

If new cancer is detected during follow-up, it will be treated with surgery, chemotherapy, or radiation therapy, as described. Even with recurrence, the chance of cure is good.

Living with testicular cancer

A cancer diagnosis is often stressful and confusing. Good information about your disease can help you feel more in control. Talk with your health care team and learn as much as you can. The more informed you are, the better able you will be to make choices about your care.

Living with one testicle

A man can usually do everything with one testicle that he would have done with two. If appearance is a concern, a false testicle (silicone implant) might be an option for a more natural look and feel. Treatment can affect semen quality, but most men with one testicle are able to father children. Some may need treatment to restore normal hormone levels of testosterone.

Treating low testosterone

 

testosterone target organs

Fig. 6: testosterone: target organs

Symptoms of low testosterone are not very specific but may include tiredness, low sex drive, erectile dysfunction, gynecomastia (swelling of breast tissue in men), or decreased body hair or beard growth. Sometimes men with normal testosterone levels also have these symptoms after treatment. Blood tests can confirm if low testosterone is the likely cause of these symptoms. Learn more about testosterone deficiency here.

Protecting your partner

Testicular cancer is not an infection. You cannot pass cancer cells to your partner during sex, and ejaculation will not make your cancer worse. If you are having chemotherapy, use a condom during sex. This will protect your partner from contact with the drugs in your semen.

Dealing with sexual issues

Removing one testicle should not take away your sexual ability or fertility. Most men can have a normal erection after surgery. However, some sexual difficulties are common after a diagnosis of testicular cancer. The ability to ejaculate may change after surgery. If you have any of these problems, counselling or medical treatment may help.

Before you have your abdominal lymph nodes removed, talk to your surgeon about possible side effects. Your sex life can be affected by this surgery:

  • RPLND can cause your semen and sperm to go backward into your bladder instead of coming out of your penis (retrograde ejaculation). Your orgasms will feel different because they will be dry. Medication helps sometimes, but you might not be able to have children by natural sexual intercourse.
  • RPLND can cause nerve damage that can make you lose the ability to have erections.

You may find it hard to talk with your doctor or your partner about sexual problems. After all, your sex life is very personal. But doctors and nurses have treated many men with similar problems and are used to talking about them. You can ask your doctor or nurse to refer you to a specialist counsellor or a sex therapist.

Managing low sex drive

You may find that you have less sexual desire (libido) than usual, at least for a while. This is perfectly normal. Any testicular cancer treatment can make you feel like this. Feeling tired or sick can also lower your libido. So can emotions such as fear, anxiety and anger. Once treatment is done and you are living with having had cancer, you will find your libido comes back.

Preserving fertility

Poor semen quality after testicular cancer treatment can make it difficult for some men to father children. Before treatment begins, tell your doctor if you wish to have children. You might want to have semen analysis and preserve sperm samples in a sperm bank for later use.

Sperm banking is when you produce a semen sample for later use. You might be one of the few men who cannot produce a semen sample or who has no sperm or very few sperm in his semen. If so, there is still a possibility that there may be usable sperm somewhere in your testicles. Sometimes sperm can be taken directly from samples of healthy testicle tissue. Banked sperm can be used to fertilize an egg immediately, or it can be frozen and used later.

Handling social and psychological effects

A cancer diagnosis can have a big impact on your life and the lives of your loved ones. Cancer can make you feel powerless. It can make you feel anxiety, anger, fear, or depression. Some patients are exhausted during or after treatment. It is very common to worry about the cancer coming back. During treatment you will be away from your work. Talk to your boss about the best way for you to get back to work. Perhaps you could work part time or in a different function.

Find support or treatment for these issues. Talk with your doctor or nurse in the hospital or ask your family doctor. Your health care team can refer you to patient organizations or others who can help you with psychological support or practical matters like financial advice.

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