Follow-up after treatment for testicular cancer
After your treatment has finished, you will be asked to go back to the hospital for regular check-ups.
To begin with, these may be every month but they will gradually become less frequent. Your doctor will ask how you are feeling and will examine you. Your remaining testicle will also be checked. You may have blood tests.
From time to time you may also have a CT scan, chest x-ray or ultrasound scan. You can also see your GP or hospital doctor if, between your follow-up visits, you have a symptom which you cannot readily explain or is not getting better.
For men whose treatment is over apart from regular check-ups, our booklet on adjusting to life after cancer treatment gives helpful advice on how to keep healthy and adjust to life after cancer.
How treatment for testicular cancer might affect your fertility and sex life
One of the most common questions asked by men before treatment for testicular cancer is whether their sex life or fertility will be affected.
The important thing to remember is that, if the other testicle is healthy, the removal of one testicle will not affect your sexual performance or your ability to father children. This is because the remaining healthy testicle will produce more testosterone and sperm to make up for the removal of the affected testicle.
Effects of chemotherapy
Chemotherapy treatment for men with testicular cancer commonly causes infertility during treatment and for a time after. This is usually temporary but your doctor will advise that you consider storing sperm before having treatment. The rate at which the sperm count recovers varies from person to person, but it generally returns to normal from around 18 months or so after treatment. In men having high-dose chemotherapy, the risk of infertility is higher.
The effect of chemotherapy on semen (the liquid that contains the sperm) and sperm is uncertain. Condoms should be used during sex within the first 48 hours after chemotherapy to protect your partner from any of the drug that may be present in semen. Although there is no evidence that chemotherapy can harm children fathered after the treatment has finished, doctors usually advise you to avoid conceiving a child for about a year after treatment.
Some men with testicular cancer have a low sperm count before they start any treatment, and sometimes successful treatment with chemotherapy may actually cause the sperm production to improve.
Effect of surgery to remove lymph nodes
Sometimes it is necessary to surgically remove lymph nodes in the abdomen (retroperitoneal lymph node dissection), if they are still enlarged after radiotherapy or chemotherapy. Unfortunately, this can affect fertility, as the operation can damage the nerves that control the discharge of sperm through the penis (ejaculation). However, new surgical techniques mean that this problem can usually be avoided. If there is a possibility that you may need such surgery, and if you are fit enough to produce sperm samples for storage before treatment starts, some of your sperm can be stored.
Although this further surgery may make it more difficult for you to father a child, it will have no physical effect on your ability to get an erection or have an orgasm.
Effect of radiotherapy
Radiotherapy does not normally cause infertility. However, a small dose of radiation does reach the remaining testicle. There is no evidence that this radiotherapy has any effect on children fathered after the treatment, but men are usually advised to use effective contraception for 6-12 months after treatment has ended.
Low sex drive
Any course of treatment may make you too tired to be interested in sex, and lower your sex drive. This is common to many illnesses, not just cancer. It is worrying, but remember that it is a temporary side effect. Once the treatment is over and your body begins to return to normal, your sex drive (libido) will also return.
Sexual problems are very personal - and important. Talking about them can be a great help.
Although this can sometimes be difficult, once they have summoned up the courage to talk openly to their partners, many men find that their fears of rejection are unfounded. Sexual relationships are built on many things including love, trust and common experiences. You may even find a new closeness after talking through a problem with your partner.
In some cases your doctor or nurse or a close friend or relative may also be able to offer help and advice. Some hospitals have nurses or social workers who have been specially trained to help people with sexual problems.
We have a booklet on sexuality and cancer which you may find helpful.
One common fear is that cancer cells can be passed on to your partner during sex. This is not true. Cancer is not infectious and it is perfectly safe for you to have sex.
Sperm storage before treatment for testicular cancer
For many men, it is possible to preserve their fertility by storing sperm (sperm banking). If your sperm is suitable and you would like to store some for the future, you will need to produce a number of sperm samples over a period of a few days. These can be frozen and stored for some time by the hospital. When you want to father a child, your sperm can be thawed and used to artificially inseminate your partner.
Unfortunately, not every man has sperm suitable for banking. To be successfully stored, a sample must contain a certain number of active sperm cells, which would be able to fertilise a female egg. However, new techniques now make it possible for less active sperm to be effective. Active sperm can also sometimes be taken from the testes, even when there are none in the semen.
It is best to discuss possible sperm storage with your doctor before your treatment starts, so that tests can be done to check your sperm count.
For many patients with cancer, the cancer unit will provide free sperm banking, but if the hospital has to pay for this service they may charge you. The costs vary between hospitals.
If your doctor feels that it is important to start chemotherapy treatment very soon, there may not be enough time to arrange for sperm banking to be done before treatment starts.