Side effects of testicular cancer treatment

Orchidectomy

The loss of one testicle is not a major problem, provided that the opposite testis is normal. Cosmesis is seldom a problem, but if necessary a testicular prosthesis can be inserted into the empty scrotal sac.

Retroperitoneal lymph node dissection

Historically this operation used to lead to retrograde ejaculation (ejaculationof sperm into the bladder) due to damage to the sympathetic nerves. This caused functional infertility. Modern day modifications to the surgical technique have greatly reduced the incidence of this problem.

Radiotherapy

The total radiation dose is low, leading to minor degrees of nausea and vomiting only. Radiotherapy to the para-aortic and pelvic nodes inevitably causes some scatter irradiation to reach the testicle, despite testicular shielding during treatment. If the testis receives less than 1 Gray of radiation the chances of recovery is more or less 100%. A dose of 6-8 Gray to the testicle leads to permanent infertility.

Chemotherapy

Cisplatin causes azoospermia (absence of sperm) in most patients. This usually recovers after 3-4 years. Cisplatin and Ifosfomide are both toxic to the kidneys. Most of the chemotherapeutic agents cause nausea and vomiting. This side effect can normally be combated very effectively with anti-nausea medication. All chemotherapeutic agents tend to suppress the bone marrow. Hair loss is the rule rather than the exception. The risk of developing secondary cancer is increased in patients who have had chemotherapy or radiation, but fortunately the incidence is low.

Previously reviewed by Dr Pieter J le Roux MBChB, FRCS(Eng), FRCSI, FCS(SA)Urol.

Reviewed by Dr David Eedes, Oncologist, February 2011