Long-term morbidity and quality of life in testicular cancer patients

Today about 90% of patients with testicular cancer can be cured. The consideration of treatment-related long-term morbidity has, therefore, become an important issue. Cisplatin-based chemotherapy induces long-lasting Raynaud-like phenomena and/or peripheral sensoric, usually mild, neuropathy in 30-40% of the patients. Irreversible reduction of renal function is a frequent finding after chemotherapy, especially if high doses of cisplatin are given. Abdominal radiotherapy is generally well tolerated but may lead to slight chronic meteorism and dyspepsia. 'Dry ejaculation' represents the principal sequelae after retroperitoneal surgery. The frequency of this side effect can be reduced by nerve-sparing surgery. Both chemotherapy and radiotherapy reduce spermatogenesis transiently. About 2 years after discontinuation of treatment, sperm production has recovered in most of the patients with normal pretreatment gonadal function. At least half of the patients with a desire for post-treatment paternity are able to father a child after their treatment. Assisted fertilization may reduce post-treatment infertility problems for individual couples. In general, cured testicular cancer patients are more satisfied with life than an age-matched control group, but may present a greater fluctuation of their mood and affect. In conclusion, most cured testicular cancer patients enjoy a normal life if precaution is taken to reduce therapy-related side effects to a minimum. However, reduction of the complication rate would not lead to a decrease of the present high cure rate of this malignancy.