As survival rates for testicular cancer (TC) improve, new challenges have emerged. Platinum-based chemotherapy is associated with a seven-fold increased risk of cardiovascular disease, and approximately one in five TC survivors develops metabolic syndrome, which significantly contributes to long-term mortality.
Recognising this growing issue, Memorial Sloan Kettering (MSK) Cancer Centre, New York City, US, decided to take action.
“Today, most men with TC, even those with advanced disease, are cured. But with that success comes a new challenge. Many survivors go on to develop metabolic syndrome, impacting not just lifespan, but health span. And yet, metabolic screening is not consistently integrated into routine oncology care,” Ms Maryann Carousso, a nurse practitioner at MSK’s Sidney Kimmel Centre for Prostate and Urologic Cancers, told the 2026 John Fitzpatrick Irish Genitourinary Cancer Conference.
“At MSK, approximately 50 to 60 men receive outpatient chemotherapy each year, creating an opportunity to integrate structured metabolic screening into routine care. The clinical problem at MSK was a lack of a standardised process for metabolic syndrome screening, resulting in missed opportunities for early risk identification and intervention.”
The hospital introduced a structured, standardised metabolic screening process which was aligned with the patient’s chemotherapy regimen. Patients undergo baseline screening on day one of the first chemotherapy cycle. Metabolic measures are recorded, including anthropometrics with waist circumference, fasting metabolic laboratory results, and morning testosterone. Patients are then followed at regular intervals after treatment, with management guided by risk level, ie, the number of metabolic syndrome criteria met.
“For patients at low risk, defined as zero to one criterion, management focuses on lifestyle modification including weight management, regular physical activity, and a heart healthy Mediterranean style diet with annual re-screening. For those at moderate risk with two criteria, lifestyle interventions are intensified and targeted referrals are considered. This may include nutritional support, primary care or cardiology for hypertension or dyslipidaemia, endocrinology for elevated glucose, and men’s sexual health for low testosterone.
“Re-screening is recommended within six to 12 months. Patients with three or more criteria meet the definition of metabolic syndrome and require more intensive management. This includes treatment of identified risk factors, consideration of pharmacologic therapy, and closer follow-up typically at six months,” Ms Carousso explained.
To date, 31 patients have been screened. “Most were low risk, but about 16 per cent were identified as moderate to high risk, which really highlights the value of early screening. Importantly, several of these patients required initiation of antihypertensive and/or lipid-lowering therapy, showing that this approach can directly inform targeted interventions,” she said.
Ms Carousso concluded by saying: “Our experience demonstrates that metabolic screening is feasible within routine oncology care and supports early risk-based intervention. Importantly, this approach is scalable and has the potential to be applied more broadly across oncology populations.”
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