A new study has examined sexual function and quality of life for survivors of bilateral testicular cancer.
Testicular cancer affects the testicles (or testes), two small glands located in the scrotum. The testes are responsible for producing sperm cells and male sex hormones like testosterone.
One way oncologists classify testicular cancer is by its location. Unilateral cancer affects just one testicle. Bilateral cancer affects both testicles, either at once or at separate times. According to the American Society of Clinical Oncology, about 2% of men with testicular cancer have the bilateral type.
Some men have one or both testicles surgically removed in a procedure called an orchiectomy. Men who have one remaining testicle usually have normal sexual function afterward, as the testicle can still make enough testosterone and sperm on its own. But if both testicles are removed, the lack of testosterone can lead to sexual problems like low desire and erectile dysfunction (ED). Men will also become infertile if both testicles are removed.
The study involved 2,479 testicular cancer survivors in Denmark. Ninety-three had had both testicles removed, and 126 had received contralateral (affecting the opposite testicle) radiotherapy for germ cell neoplasia in situ (TC + GCNIS). The remaining 2,260 men had been treated for unilateral testicular cancer and served as a comparison group. Overall, a median of 17 years had elapsed since the men’s cancer diagnosis.
The men completed questionnaires that assessed their erectile function, anxiety and depression symptoms, and fatigue.
Ninety-five percent of the men in the bilateral group received testosterone replacement therapy, compared to 5% of the unilateral group and 51% of the TC + GCNIS group.
About a quarter of the men in the bilateral group had erectile dysfunction. Rates were lower in the unilateral (18%) and TC + GCNIS (17%) groups. Anxiety rates were 32%, 20%, and 26%, respectively. Scores on the fatigue assessment were similar for the three groups.
“Our findings suggest that [bilateral testicular cancer] survivors in the present cohort were sufficiently treated with [testosterone substitution] to avoid [sexual dysfunction],” the authors wrote.
They added, “The findings are reassuring and provide a basis for a positive message in relation to future sexual life in counseling young men who undergo treatment for [bilateral testicular cancer].”
They also recommended further research on anxiety risk in this population.
The study was published online in November 2018 in European Urology Focus.
Resources
American Cancer Society
“What Is Testicular Cancer?”
(Last revised: May 17, 2018)
https://www.cancer.org/cancer/testicular-cancer/about/what-is-testicular-cancer.html
American Society of Clinical Oncology
“Testicular Cancer: Treatment Options”
(Approved: November 2017)
https://www.cancer.net/cancer-types/testicular-cancer/treatment-options
European Urology Focus
Bandak, Mikkel, et al.
“Sexual Function and Quality of Life in a National Cohort of Survivors of Bilateral Testicular Cancer”
(Full-text article in press. Published online: November 24, 2018)
https://www.eu-focus.europeanurology.com/article/S2405-4569(18)30359-6/fulltext
International Society for Sexual Medicine
“How might removal of one or both testicles affect a man’s sex life?”
https://www.issm.info/sexual-health-qa/how-might-removal-of-one-or-both-testicles-affect-a-mans-sex-life/
