Out of our cohort of 40 patients, 33 patients (82.5%) rated their prosthesis as either good or excellent, and 35 patients (87.5%) would have the TP implanted again. The most common complaint among patients was the prosthesis being too firm (44%). Appropriate prosthesis size (p=0.0012), position (p<0.0001), and comfort (p<0.0001) were significantly associated with higher satisfaction rates. Eight patients (20%) received their TP with a secondary procedure after orchiectomy (i.e., retroperitoneal lymph node dissection), which was associated with lower satisfaction (p=0.035). We find this cohort of particular importance as they may have not been offered a TP at the initial orchiectomy, but still chose to have one later. These men may have lower satisfaction rates as the transition back to two testes may be difficult after having adapted to one testis. Despite this, none of our patients have requested removal of their TP, and some have even declined the option to remove it (due to discomfort or complaints over fit) after being offered in clinic.
Although there is no published data on rates of TP placement in the United States, many testicular cancer patients have their orchiectomies performed by urologists in a community setting, where they are less likely to be offered a prosthesis. Some urologists may not be familiar with TP due to the setting and/or era in which they trained, while others may not find them useful based on anecdotal evidence. As a reminder, only saline-filled testicular prostheses are FDA-approved in the United States. Currently, only one brand is available in the United States (Coloplast®, Minneapolis, MN), and they come in three sizes (small, medium, or large). Saline-filled prostheses have been shown to be safe to be placed at the time of orchiectomy with few adverse events.8 Although some urologists may feel that their patients will decline a TP, this should not preclude them from routinely offering the option at the initial discussion of the orchiectomy.
To the best of our knowledge, our study is the largest cohort to date examining satisfaction rates with saline-filled TP in men with testicular cancer, and overall, our patients are largely satisfied with their TP. However, our study has also illustrated areas for improvement in TP and testicular cancer. Currently, no validated questionnaire exists for assessing patient satisfaction specifically with TP. Validation of a questionnaire, like our own, may better demonstrate areas for improvement. Results from such a questionnaire may also improve insurance coverage by demonstrating that TP fulfill a greater need beyond cosmetic purposes. With only one brand available, there are no alternative options for patients who are unhappy with their TP, and development of different filling material is clearly warranted. There are also few resources about TP available for physicians or prospective patients9, including the National Cancer Care Network (NCCN) guidelines. The NCCN guidelines for testicular cancer only recently added to “consider testicular prosthesis” in their 2017 update. Although our study aims to contribute to this need, further research is needed examining larger cohorts over multiple institutions to better assess rates of TP use and patient satisfaction.
Conflict of interest: Neither the study or authors are paid consultants for Coloplast®, and there are no other conflicts of interest.
Written by: Madeleine L. Burg, MD Candidate at Keck School of Medicine of USC and Siamak Daneshmand, MD Associate Professor of Urology (Clinical Scholar)
Director of Clinical Research, Keck School of Medicine USC
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