PURPOSE: Testicular seminoma mainly affects young men in the second to fourth decades of life. Stage I seminoma has a cure rate approaching 99%, resulting in long-term survival after treatment. Toxicities or complications of treatment for more extensive seminomas are known to cause long-term morbidities, however little has been documented regarding patients with stage I seminoma following curative treatment. In this systematic review, we examined existing literature regarding late effects in patients with stage I testicular seminoma treated with surgical orchiectomy.
METHOD: Publications were identified through an electronic literature search using the MEDLINE, EMBASE and PsychInfo databases, identifying late effects in cohorts with stage I seminoma. Effects were classified as physical (bone health, cardiac, metabolic syndrome, renal function, second malignancy, fertility, hypogonadism and sexual function) or psychological (cognition, depression, fatigue and quality of life).
RESULTS: 600 articles were screened to identify 128 relevant studies. Overall there was conflicting evidence about increased cardiovascular risk in patients treated with orchiectomy. As expected, orchiectomy alone was not associated with osteoporosis or renal impairment. Increased rates of second malignancy was restricted to patients receiving multi-modality treatment. 5 studies showed an increased incidence of contralateral testicular cancer. Baseline sperm counts were low in most patients however data regarding fertility was inconsistent. Psychological late effects included anxiety and chronic fatigue, with diverging data regarding depression, quality of life, suicidal risk and sexuality. Heterogeneity of study design and under-reporting of effects contributed to uncertainty regarding the true incidence and clinical significance of late effects.
CONCLUSIONS: Additional data are needed on the prevalence of late effects following orchiectomy alone. The curability of stage I seminoma and the range of possible late effects of treatment support the need for long-term monitoring alongside standard cancer surveillance. Awareness and screening for these late effects may prevent further morbidity in these men.