By Matt S. Ashley, MD, SMGOR – Bend Urology Associates
Treatment of testicular cancer has become one of the great successes of modern oncologic care. Through years of diligent research, innovation and a little luck, cure rates typically exceed 90% — even for widely metastatic disease. Close collaboration between urologic surgeons, medical oncologists and radiation oncologists have resulted in some of the most successful treatment pathways of any tumor.
Testicular cancer patients are unique not only in their cancer outcomes, but also in the issues they face after the therapy is complete. Whereas the vast majority of cancer patients we treat in urology are over the age of 65, most young men with testicular cancer are between 18 and 40 years old. We as clinicians have been far too slow in recognizing the special challenges faced by testicular cancer survivors. We now strive to provide a comprehensive plan of care following treatment that addresses the hormonal, sexual, reproductive and social impact of the disease.
Fertility is usually at the front of most men’s concerns while undergoing treatment. To address this worry, male patients are offered sperm banking before any surgery, chemotherapy or radiation is performed. Chances of future paternity issues can be reduced by varying amounts depending on the treatment, so we recommend sperm preservation to any interested patient. There are also numerous foundations that assist with the costs associated with sperm banking for these men. Men with testicular cancer are also known to have increased rates of hypogonadism (low testosterone) after treatment. This can be the result of exposure to chemotherapy or radiation, but likely also reflects some degree of baseline dysfunction in the remaining testicle. Young men with a history of testicular cancer should be screened for low testosterone since hormonal replacement can improve quality of life significantly in the appropriate setting. Similarly, we see earlier onset of erectile dysfunction in these patients and counsel them regarding treatment options from the outset.
Unfortunately, testicular cancer survivors are faced with adversity as they return to work, school or family after having their lives turned upside down by the disease. In the past we expected these young men to simply pick up where they left off before their diagnosis. However, we now know that many testicular cancer survivors struggle to find their place after treatment is complete. There is often a perception among their peers that they have “beaten” cancer and should only feel joy and gratitude when in reality, many testicular cancer survivors experience feelings of isolation and anxiety, particularly surrounding their years of cancer surveillance visits.
We currently offer a wide array of services to these men to address the psychological and social challenges of being a young cancer survivor. There are specially trained counselors available to help, as well as numerous complimentary providers such as acupuncture and nutritionists to ensure all aspects of survivorship are being addressed.
Medicine has made tremendous progress in treating men with testicular cancer, but we are now realizing that the cure is just the beginning.
Matt S. Ashley, MD
Dr. Ashley treats all aspects of urology and specializes in robotic surgeries. He also has a special interest in urologic cancers, prostatic enlargement, erectile dysfunction, kidney stones, testosterone replacement and Peyronie’s disease. Dr. Ashley received his undergraduate degree from Princeton University and obtained his medical degree from Oregon Health & Science University in Portland, Oregon. He practiced for one year in Washington after completing his residency at the USC Institute of Urology in Los Angeles, California before relocating back to his home state of Oregon.
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