Long-term cardiovascular and metabolic risks identified in testicular cancer survivors

TUH study supports the roll-out of a national ANP-led screening model for testicular cancer survivors

A new study from Tallaght University Hospital (TUH) has highlighted the need for long-term surveillance of testicular cancer survivors, revealing a significant burden of cardiovascular and metabolic complications among men more than five years post-treatment.

Testicular cancer, the most common malignancy in males aged 15-35, has an excellent prognosis, with cure rates exceeding 95 per cent. However, emerging evidence indicates that survivorship is associated with an elevated risk of chronic health conditions.

The observational study, recently published in Supportive Care in Cancer, found that survivors are experiencing early-onset hypertension, dyslipidaemia, renal impairment, and secondary malignancies – risks typically not anticipated until much later in life.

The TUH study reports on 78 men enrolled in an Advanced Nurse Practitioner (ANP)-led testicular cancer survivorship clinic at the hospital, which was established in October 2022. All participants were at least five years post-diagnosis, with a mean interval of 10 years since treatment completion.

During structured annual assessments, 40 per cent were found to have hypertension and 55 per cent had dyslipidaemia. Dyslipidaemia was clearly predominant in the patients who received chemotherapy, accounting for more than 85 per cent of patients. It was also more common in testicular cancer survivors diagnosed at >30 years of age. Only a small minority (13 per cent) of the men were aware of this underlying condition, as most of them were diagnosed on screening.

Notably, one of the screened men had suffered a myocardial infarction at the age of 45, and two cases of coronary artery disease were identified.

At the median follow-up of 12 years, Raynaud’s phenomenon was reported by 12 (15 per cent) patients, all of whom received chemotherapy for treatment of their testicular cancer. Both men diagnosed with coronary artery disease had Raynaud’s phenomenon as well, which underscores the close relationship between the two complications.

In addition, three of the screened men died from a second malignant neoplasm, and six were referred for nephrological follow-up and monitoring due to impaired renal function.

The TUH screening clinic model, established by oncology ANP Patrice Kearney Sheehan and now consultant oncologist Dr Raheel Khan, was developed in response to international data showing elevated cardiovascular mortality in this patient group. Studies from Norway and the US have previously linked testicular cancer treatment – particularly cisplatin-based chemotherapy and radiotherapy – with long-term vascular and metabolic sequelae.

Dr Khan described the results as “astonishing”.  “We know from research carried out in recent years that men who have been successfully treated for testicular cancer die much younger than normal,” he noted. “Early screening can identify and successfully treat many of the complications they face, such as high blood pressure and high cholesterol, particularly important when this research tells us that one of the men we studied had suffered a heart attack at the age of just 45. The study identifies the need for more specialist ANP-led survivor clinics. Unlike TUH, most cancer centres do not offer any follow-up at the end of surveillance for testicular cancer patients.”

Early screening can identify and successfully treat many of the complications they face, such as high blood pressure and high cholesterol..

 The TUH findings support the implementation of structured long-term, multidisciplinary survivorship screening, including annual cardiovascular and metabolic assessments, in men treated for testicular cancer to improve early identification of and management of modifiable risk factors.

Prof Ray McDermott, Clinical Professor of Medical Oncology at TUH and the Clinical Lead at Cancer Trials Ireland, said: “This new research paper provides a practical solution to issues faced by men who have been treated for testicular cancer. We are hoping that further studies will build on this knowledge and improve survivorship care as well as raise awareness among healthcare providers and survivors. Five decades ago, testicular cancer patients emerged as pioneers in solid organ cure; now, they can become the pioneers in survivorship care.”

The study was supported by Cancer Trials Ireland.

Reference

Khan M, Sheehan PK, Bazin A, Farooq AR, Leonard C, Aleem U, Corrigan L, McDermott R. Long-term side-effects of testicular cancer and treatment (observational study of mortality and morbidity in testicular cancer survivors). Support Care Cancer. 2025 Apr 24;33(5):413