Thromboembolic events after high-intensity training during cisplatin-based chemotherapy for testicular cancer: Case reports and review of the literature.

The randomized "Testicular cancer and Aerobic and Strength Training trial" (TAST-trial) aimed to evaluate the effect of high-intensity interval training (HIIT) on cardiorespiratory fitness during cisplatin-based chemotherapy (CBCT) for testicular cancer (TC). Here, we report on an unexpected high number of thromboembolic (TE) events among patients randomized to the intervention arm, and on a review of the literature on TE events in TC patients undergoing CBCT. Patients aged 18 to 60 years with a diagnosis of metastatic germ cell TC, planned for 3 to 4 CBCT cycles, were randomized to a 9 to 12 weeks exercise intervention, or to a single lifestyle counseling session. The exercise intervention included two weekly HIIT sessions, each with 2 to 4 intervals of 2 to 4 minutes at 85% to 95% of peak heart rate. The study was prematurely discontinued after inclusion of 19 of the planned 94 patients, with nine patients randomized to the intervention arm and 10 to the control arm. Three patients in the intervention arm developed TE complications; two with pulmonary embolism and one with myocardial infarction. All three patients had clinical stage IIA TC. No TE complications were observed among patients in the control arm. Our observations indicate that high-intensity aerobic training during CBCT might increase the risk of TE events in TC patients, leading to premature closure of the TAST-trial.

Healthcare Professionals' Attitudes to Rehabilitation Programming for Male Cancer Survivors.

PURPOSE: The purpose of this study is to describe and interpret the attitudes and conduct of hospital healthcare professionals (HCPs) in association with male cancer survivors and their municipal rehabilitation participation. DESIGN: Ethnographic fieldwork was conducted, consisting of participant observation and nine semistructured focus group interviews with 58 hospital HCPs. METHODS: Using interpretive description methodology with symbolic interaction as a theoretical framework, data were collected through fieldwork in three oncology wards in Denmark. FINDINGS: Attitudes about both gender and rehabilitation were identified as overarching obstructions within hospital HCP conduct toward promoting men's participation in cancer rehabilitation. CONCLUSIONS: Gender and rehabilitation perceptions formed barriers in this context, suggesting that male cancer survivors' rehabilitation outcomes may be compromised by HCP attitudes and conduct. CLINICAL RELEVANCE: These findings provide insight into approaches to guide HCPs to take responsibility for rehabilitation and to take gender into account in their work.

Effects of high-intensity aerobic interval training on cardiovascular disease risk in testicular cancer survivors: A phase 2 randomized controlled trial.

BACKGROUND: Testicular cancer survivors (TCS) have an increased risk of treatment-related cardiovascular disease (CVD), which may limit their overall survival. We evaluated the effects of high-intensity aerobic interval training (HIIT) on traditional and novel CVD risk factors and surrogate markers of mortality in a population-based sample of TCS. METHODS: This phase 2 trial (ClinicalTrials.gov identifier NCT02459132) randomly assigned 63 TCS to usual care (UC) or 12 weeks of supervised HIIT (ie, alternating periods of vigorous-intensity and light-intensity aerobic exercise). The primary outcome was peak aerobic fitness (VO2peak ) assessed via a treadmill-based maximal cardiorespiratory exercise test. Secondary endpoints included CVD risk (eg, Framingham Risk Score), arterial health, parasympathetic nervous system function, and blood-based biomarkers. RESULTS: Postintervention VO2peak data were obtained for 61 participants (97%). HIIT participants attended 99% of the exercise sessions and achieved 98% of the target exercise intensity. Analysis of covariance demonstrated that HIIT was superior to UC for improving VO2peak (adjusted between-group mean difference, 3.7 mL O2 /kg/min; 95% confidence interval, 2.4-5.1 [P<.001]) and multiple secondary outcomes including CVD risk (P = .011), arterial thickness (P<.001), arterial stiffness (P<.001), postexercise parasympathetic reactivation (P = .001), inflammation (P = .045), and low-density lipoprotein (P = .014). Overall, HIIT reduced the prevalence of modifiable CVD risk factors by 20% compared with UC. CONCLUSIONS: This randomized trial provides the first evidence that HIIT improves cardiorespiratory fitness, multiple pathways of CVD risk, and surrogate markers of mortality in TCS. These findings have important implications for the management of TCS. Further research concerning the long-term effects of HIIT on CVD morbidity and mortality in TCS is warranted. Cancer 2017;123:4057-65. © 2017 American Cancer Society.

Dismantling the present and future threats of testicular cancer: a grounded theory of positive and negative adjustment trajectories.

PURPOSE: Testicular cancer commonly affects men in the prime of their lives. While survival rates are excellent, little previous research has examined men's experiences of adjustment to survivorship. We aimed to explore this issue in younger testicular cancer survivors. METHODS: In-depth qualitative interviews were conducted with testicular cancer survivors over two time points approximately 6 months apart in the year following treatment completion. Interviews were analysed using a grounded theory approach. RESULTS: The sample included 18 testicular cancer survivors between 22 and 44 years (mean age 34). A grounded theory was developed, which explained the process of positive adjustment over the first year following the treatment completion in terms of men's ability to dismantle the present and future threats of cancer, involving the key transitions of gaining a sense of perspective and striving to get on with life and restore normality. These were facilitated by six key processes. The processes that explained a negative adjustment trajectory are also presented. CONCLUSIONS: These findings contribute to the understanding of the psychosocial impact of testicular cancer on younger men's lives and have implications for the provision of support to testicular cancer survivors. Further investigation into the feasibility of one-on-one peer support interventions is warranted, as well as informal support that respects men's desire for independence. IMPLICATIONS FOR CANCER SURVIVORS: Understanding the processes involved in adjustment highlights ways in which health professionals can offer support to those struggling to adjust through challenging illness beliefs, encouraging emotional disclosure and facilitating peer mentoring.

Sperm cryopreservation before testicular cancer treatment and its subsequent utilization for the treatment of infertility.

AIMS: In this study we report our results with storage of cryopreserved semen intended for preservation and subsequent infertility treatment in men with testicular cancer during the last 18 years. METHODS: Cryopreserved semen of 523 men with testicular cancer was collected between October 1995 and the end of December 2012. Semen of 34 men (6.5%) was used for fertilization of their partners. They underwent 57 treatment cycles with cryopreserved, fresh, and/or donor sperm. RESULTS: A total of 557 men have decided to freeze their semen before cancer treatment. Azoospermia was diagnosed in 34 men (6.1%), and semen was cryopreserved in 532 patients. Seminoma was diagnosed in 283 men (54.1%) and nonseminomatous germ cell tumors in 240 men (45.9%). 34 patients who returned for infertility treatment underwent 46 treatment cycles with cryopreserved sperm. Totally 16 pregnancies were achieved, that is, 34.8% pregnancy rate. CONCLUSION: The testicular cancer survivors have a good chance of fathering a child by using sperm cryopreserved prior to the oncology treatment, even when it contains only limited number of spermatozoa.

Sexuality and body image in long-term survivors of testicular cancer.

OBJECTIVE: This study explores sexual function and the influence of different treatment modalities on sexual function and body image among long-term survivors of testicular cancer (TCSs). METHODS: A long-term follow-up assessment of all testicular cancer patients treated at Aarhus University Hospital, Denmark, from 1990 to 2000 was conducted. A total of 401 survivors (mean age: 46.6years; response rate: 66%) completed questionnaires concerning sexuality and changes in body image. Based on the treatment received, patients were categorised into one of four groups: surveillance, radiotherapy, chemotherapy, or chemotherapy supplemented with retroperitoneal lymph node dissection (RPLND). RESULTS: Sexual dysfunctions were reported: 24% reduced sexual interest, 43% reduced sexual activity, 14% reduced sexual enjoyment, 18% erectile dysfunction, 7% ejaculatory problems and 3% increased sexual discomfort. Seventeen percent of the long-term TCSs reported changes in body image, and this was significantly associated with all six parameters of sexual dysfunction. When comparing treatments, only the RPLND procedure was associated with sexual dysfunction in the form of ejaculatory dysfunction. CONCLUSION: Apart from RPLND, which was associated with ejaculatory dysfunction, treatment strategies for testicular cancer appeared not to influence sexual dysfunction. The level of erectile dysfunction seen in this sample of TCSs seemed to be higher than the level observed in the general male population and high levels of erectile dysfunction were associated with negative changes in body image. The results suggest that changes in body image are of importance when explaining the variation in sexual dysfunctions, but further prospective studies are needed to clarify this issue.

Role of radiotherapy in organ-sparing treatment of seminoma.

Radical orchiectomy is the standard treatment for patients with seminoma. In both bilateral and unilateral testicular cancer, this therapy results in infertility, permanent androgen replacement treatment and significant psychological problems stemming from castration. Given that most patients with germinal cell tumours are long-term survivors, quality of life is becoming more and more relevant in therapeutic decision-making. We present a case of metachronous bilateral seminoma treated with tumour enucleation and adjuvant local radiotherapy. We also provide a review of the literature on the role of radiotherapy in organ sparing.

Role of radiotherapy in organ-sparing treatment of seminoma

Radical orchiectomy is the standard treatment for patients with seminoma. In both bilateral and unilateral testicular cancer, this therapy results in infertility, permanent androgen replacement treatment and significant psychological problems stemming from castration. Given that most patients with germinal cell tumours are long-term survivors, quality of life is becoming more and more relevant in therapeutic decision-making. We present a case of metachronous bilateral seminoma treated with tumour enucleation and adjuvant local radiotherapy. We also provide a review of the literature on the role of radiotherapy in organ sparing (AU)

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Testicular cancer patients: considerations in long-term follow-up.

Over the past 30 years, testicular tumors have become the paradigm for a curable adult cancer. Numerous factors have contributed to this success, including the introduction of newer treatment approaches, such as cisplatin-based combination chemotherapy and curative retroperitoneal lymph node dissection. Moreover, the last three decades have witnessed the evolution of newer diagnostic methods, improvements in staging, the evaluation of patient response, and the monitoring of relapse. These treatment successes have been accompanied by the emergence of the late effects of testicular cancer and its treatment, including second primary cancers, cardiovascular sequelae, the metabolic syndrome, gonadal toxicity, neurotoxicity, and pulmonary sequelae. An overview of these late effects and recommendations for patient follow-up are presented in this article.

Self-perceived physical, psychologic, and general symptoms in survivors of testicular cancer 3 to 13 years after treatment.

Due to the large group of patients with advanced testicular cancer now being cured, it is important to identify the men who are at risk of deteriorated health. The purposes of this study were: (1) to delineate and compare frequency of self-perceived physical, psychologic, and general symptoms in men treated for testicular cancer with those of a general population sample and (2) to compare self-perceived physical, psychologic, and general symptoms in relation to secondary Raynaud phenomena, sexual dysfunction, infertility, and self-perceived attractiveness in different treatment modalities. The subjects were 277 survivors of testicular cancer (M = 42.2 years) who had completed a self-reported questionnaire (75.5% response rate). A population survey comprising 392 men was used as a comparison group (M = 45 years). The result demonstrated that although survivors of testicular cancer as a group reported significantly less frequency of backache, leg pain, cough, and eye problems than did the general population sample, they described that they significantly more often felt cold. Men reporting secondary Raynaud phenomena, infertility, and/or feeling less attractive had experienced significantly more self-perceived symptoms. Oncologist nurses could play an important role in psychologic counseling for those men.

[Radical orchiectomy]. / L'orchidectomie élargie.

The authors recall that exploratory orchidotomy remains an essential operation for the diagnosis of testicular cancer and orchidectomy constitutes the primary therapeutic procedure. The operative technique is described together with its intangible principles, its difficulties and its variants. The tumour markers are best assayed on a sample of cord blood. The insertion of a testicular prosthesis, which is usually well supported, decreases the psychological effects of castration and does not cause any delay in possible adjuvant treatment.

[Rehabilitation of patients with malignant germ cell tumor]. / Rehabilitation von Patienten mit malignem Keimzelltumor.

The progress achieved in the treatment of the malignant germ cell tumor of the male is based on the introduction of cisplatin in polychemotherapy and of consistent interdisciplinary cooperation (including surgery). Thus more than 70% of testicular cancer patients are now cured long term. Early diagnosis and consistent therapy increase the chances of survival additionally. The chances of successful therapy are markedly higher in early tumor stages (90%) than in late tumor stages (less than 50%), where intensive therapy modalities are being tried (bone marrow transplantation, cytokines). After reaching complete remission, consistent follow up programmes are important in order to detect a relapse (10-15%), and to enable the patient to return to his profession. Psychosocial care is also an important factor. The patient should under no condition be pensioned off, more than 90% of the mainly very young patients (median age 20-35) can return to work after the phase of intensive therapy (3-6 months). In the case of our 222 patients, only 13 had to be pensioned and 7 received new professional training. A disabled pass should be issued, whereby the extent of the disability is reduced from at first 80%-100% to 20% after a period of 5 years. The entry into civil service and a life insurance policy are also usually possible after 5 years. To aid in the consistent and necessary follow up of this group of hopeful and highly curable patients, we have had good experiences in Bavaria with a follow up calendar.

[Cured of testicular cancer; does life just go on?]. / Genezen van zaadbalkanker; gaat het leven gewoon voort?

From 1976 through 1979 we have treated 91 patients with disseminated non-seminomatous testicular cancer with induction chemotherapy comprising cisplatin, vinblastine and bleomycin. After 4 induction cycles complete responders went on to receive maintenance therapy with cisplatin and vinblastine for a median of one year. Fifty-seven patients (63%) are at present alive and free of disease. Seven to ten years after the start of treatment we have investigated their physical, mental and social situation by means of a questionnaire and by collection of data from the charts. It appeared that 90% of the respondents were fully employed. However, over half of the men reported symptoms of polyneuropathy and 40% experienced sexual function disturbances. Part of these problems were due to the maintenance chemotherapy, which has been abandoned in our country since 1982.

Impacto de la quimioterapia en la sobrevida del cáncer testicular avanzado no seminoma / Chemotherapy impact in survival of the non seminoma testicular cancer

Es analizado el impacto de la quimioterapia en un grupo de 63 pacientes portadores de cáncer testicular avanzado, en quienes se utiliza la combinación cisplatino, vinblastina y bleomicina, obteniéndose 41 respuestas completas (65.1%) y una sobrevida actuarial de 56.5% para todo el grupo a 7 años y de 87.8% para los pacientes con respuesta completa vs. 0% el grupo con respuesta parcial y no respuesta. La toxicidad fue de carácter grave en 1 paciente (neumonitis por bleomicina) y mortal en otro

Sexual rehabilitation of urologic cancer patients: a practical approach.

Sexual rehabilitation is an important aspect of preserving a patient's quality of life after treatment for urogenital cancer. Sexual rehabilitation does not usually require a specialized program, but can be an integral part of cancer treatment. Members of the health care team can provide sexual information for the patient and partner, as well as assess the need for more intensive marital or sex therapy. This paper presents specific sexual issues related to prostate, bladder, testicular, and penile cancers.

Sexual and marital counseling with men treated for testicular cancer.

Testicular cancer patients are at risk for sexual and marital problems because their cancer and its treatment reduce their fertility and disrupt intimate relationships at a crucial life stage (age 15-34). Chemotherapy, radiotherapy and surgery have successfully increased survival rates, but at the price of infertility and sexual dysfunction. A survey of men treated for nonseminomatous tumors revealed that 20% had low levels of sexual activity, 10% had erectile dysfunction, 6% had difficulty reaching orgasm, and 38% reported decreased orgasmic pleasure. Sexual anxiety related to cancer treatment accounts for much of this dysfunction, but organic factors such as hormonal, vascular or neurologic damage may also contribute. Reactions of couples to infertility and marital conflicts common in this group are discussed. Suggestions for sexual and marital counseling are offered.