Hope found in testicular prostheses

Dr Kent Pluke, a urologist, gives us a brief rundown of testicular cancer and shares the hope that testicular prostheses give men regarding positive body image and confidence.

You can listen to this article below, or by using your favourite podcast player at pod.link/oncologybuddies

Testicular cancer unpacked

Testicular cancer represents only 1% of male cancers but is the most common tumour diagnosed in young males between the ages of 15 and 39. Approximately 2% of testicular cancers are bilateral (affect both testes) at diagnosis. The good news is of course that testicular cancers show excellent cure rates, with more than 90% of patients surviving their diagnosis. There are only a handful of risk factors for testicular cancer. These include abnormal testicular development in utero, family history of testicular cancer, and a personal history of testicular cancer.

Treatment

The treatment of testicular cancer involves removal of the affected testes and cord, and may also require chemotherapy and radiotherapy, depending on the stage of the cancer at diagnosis.

Removal of one testis doesn’t affect reproductive ability or have significant impact on the male hormone levels, as long as the contra-lateral testis is functioning normally. However, most doctors will advise doing sperm banking prior to surgery for testicular cancer. In the event of the remaining testis being abnormal, patients may then also require testosterone supplementation after their surgery. Whilst most patients who undergo testicular removal will have normal fertility and hormonal levels, they will still be left with an empty scrotal sac on the side which was removed. This problem is exacerbated in cases where both testes need removal. There are also other conditions which necessitate orchiectomy (surgical procedure to remove one or both testicles), like trauma, testicular torsion and gender reassignment.

Sexuality and attractiveness concerns

Recent studies suggest that whilst most men experience good levels of functioning and enjoy a health-related quality of life comparable to that of the general population, a minority of survivors are faced with the long-term psychosocial effects and somatic sequelae of their disease history. These include problems related to both surgery and chemotherapy. One of the major concerns highlighted was that of increased feelings of physical damage and infertility, and concerns about sexuality and attractiveness. Testicular absence can represent a psychologically traumatic experience for patients, with feelings of inadequacy, embarrassment and body shame affecting sexual health and general well-being.

Hope found in testicular prostheses

Fortunately for patients, there is hope. Testicular prosthesis is a simple and effective way to improve the physical appearance of the scrotum and maintain male sexual body image. The insertion of a prosthetic testis can be done at the time of orchiectomy, or at a later stage. It’s a quick, safe and simple procedure, where a saline-filled silicone implant is inserted into the empty scrotal sac. There are various size options available, to match the contra-lateral testis, allowing for good scrotal symmetry. The implants usually have a very similar feel to that of a real testis. It’s important to remember that these implants have no reproductive or physiological function and are purely cosmetic. Recent studies of patients who underwent testicular prosthesis implantation show very high satisfaction rates, averaging over 90%. It’s thus common practice for all patients who undergo orchiectomy, to at least be offered the option of prosthetic implantation.

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