Testicular cancer survivorship: Long-term toxicity and management.

Testicular cancer (TC) occurs most commonly in young men but, fortunately, is highly curable with surgery, chemotherapy, and/or radiation therapy.1,2 Thus, testicular cancer survivors (TCS) may live for many decades, which increases their risk of developing long-term complications related to their initial cancer diagnosis and treatment. Long-term complications may increase mortality and morbidity and decrease quality of life (QoL) in TCS relative to similar aged men without cancer.3 Therefore, a delicate balance must be struck between optimizing cure and minimizing complications. The goals of this manuscript are to: 1. Educate urologists, oncologists, and primary care physicians, as well as TCS, about the potential longterm complications of surgery, chemotherapy, and radiation therapy. 2. Make recommendations for monitoring and managing these complications. Unfortunately, for many long-term complications of TC treatment, there is limited evidence-based literature and, therefore, many of our recommendations are based on expert opinion and multidisciplinary input. The most important recommendation to decrease long-term complications is to ensure that all TC patients are treated appropriately at initial presentation to maximize cure rates and minimize overtreatment. For guidance on appropriate management, refer to the recently published Canadian Urological Association (CUA) testicular germ cell cancer consensus guideline.4 Noa Shani Shrem1, Lori Wood2, Robert J. Hamilton3, Kopika Kuhathaas3, Piotr Czaykowski4, Matthew Roberts5, Andrew Matthew6, Jason P. Izard7, Peter Chung8, Lucia Nappi9, Jennifer Jones10, Denis Soulières11, Armen Aprikian12, Nicholas Power13, Christina Canil1