Impact of Treatment Intensity on Quality of Life in Patients With Metastatic Testicular Cancer

INTRODUCTION: Testicular cancer (TC) is the most common malignancy in young men and is highly curable with platinum-based chemotherapy. With growing survivorship rates, treatment-related symptom burden and quality of life (QoL) have become increasingly important. This study evaluates the impact of different TC treatments on symptom burden and QoL. MATERIAL AND METHODS: Of 715 patients with TC and primary or postchemotherapy retroperitoneal lymph node dissection (RPLND) treated at the University Hospital Düsseldorf between 2010 and 2024, 486 eligible survivors were contacted, and 124 (25.5 %) completed a standardized questionnaire. Treatment-related symptoms, including QoL and mental health status, were assessed using the EORTC QLQ-C30 and PHQ-9 questionnaires, respectively. Results were compared with age-matched reference values from the general population. A subgroup comparison of clinical stage (CS) II patients treated with primary RPLND versus first-line chemotherapy followed by RPLND was performed to identify chemotherapy-specific effects. RESULTS: The median time between last treatment and survey response was 55 months. Twenty-four patients were treated with primary RPLND, 80 patients with adjuvant or first-line chemotherapy and RPLND, and 20 patients with multiple lines of chemotherapy and RPLND. Overall, TC survivors reported high global QoL scores comparable to age-matched normative data. The most frequent treatment-related symptoms were polyneuropathy, tinnitus, retrograde ejaculation, and circulatory disorders, particularly among patients receiving multiple lines of chemotherapy. Subgroup analysis showed that CS II patients treated with a single first-line chemotherapy reported lower social functioning and greater financial distress compared with those managed with surgery alone. Despite the physical impact, depression rates were low and similar to the general population, indicating preserved psychological well-being. CONCLUSION: TC survivors maintain good QoL comparable to the general population despite therapy-related symptoms. While persistent side effects such as polyneuropathy and tinnitus are common, their impact on QoL is limited. However, even first-line chemotherapy affects sexual health, social functioning, and financial well-being, highlighting the importance of the development of new treatment approaches and clinical studies focusing on surgery as a QoL-preserving option in selected low-metastatic cases.