An exploration of testicular cancer survivors' experience of ejaculatory dysfunction following retroperitoneal lymph node dissection-a sub-study of the PREPARE clinical trial

C Conduit; A D Hutchinson; M Leonard; S O 'Haire; M Moody; B Thomas; I Sim; W Hong; G Ahmad; N Lawrentschuk; J Lewin; B Tran; H M Dhillon

doi:10.1007/s11764-023-01489-9

An exploration of testicular cancer survivors' experience of ejaculatory dysfunction following retroperitoneal lymph node dissection-a sub-study of the PREPARE clinical trial

J Cancer Surviv. 2023 Nov 20. doi: 10.1007/s11764-023-01489-9. Online ahead of print.

Authors

C Conduit^{1

2

3}, A D Hutchinson⁴, M Leonard⁵, S O 'Haire^{1

3}, M Moody^{1

3}, B Thomas⁶, I Sim^{7

8

9}, W Hong³, G Ahmad¹⁰, N Lawrentschuk^{6

11}, J Lewin^{1

2

12}, B Tran^#^{13

14

15}, H M Dhillon^#^{16

17}

Affiliations

¹ Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
² Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, 305 Grattan St., Melbourne, VIC, Australia.
³ Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
⁴ Justice & Society, Behaviour-Brain-Body Research Centre, University of South Australia, Magill, Australia.
⁵ The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, Australia.
⁶ Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.
⁷ Endocrinology, Monash Health and Eastern Health, Clayton, VIC, Australia.
⁸ Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.
⁹ Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.
¹⁰ Andrology, Royal Children's Hospital, Melbourne, VIC, Australia.
¹¹ Urology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
¹² ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Melbourne, VIC, Australia.
¹³ Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. ben.tran@petermac.org.
¹⁴ Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, 305 Grattan St., Melbourne, VIC, Australia. ben.tran@petermac.org.
¹⁵ Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia. ben.tran@petermac.org.
¹⁶ Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.
¹⁷ Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.

^# Contributed equally.

PMID: 37981616
DOI: 10.1007/s11764-023-01489-9

Abstract

Purpose: Ejaculatory dysfunction secondary to retrograde ejaculation or anejaculation is a complication of retroperitoneal lymph node dissection (RPLND) for survivors of testicular cancer. We explored survivors' experiences of ejaculatory dysfunction following RPLND.

Methods: In a sub-study of a single-arm phase 2 clinical trial (ACTRN12622000537752/12622000542796), participants reporting ejaculatory dysfunction ≥ 6 months following RPLND were invited to complete semi-structured interviews. Purposive sampling was used. Interviews continued until thematic saturation occurred, and codebook thematic analysis of interviews was performed.

Results: Of 58 individuals recruited to the trial, 33 (57%) reported ejaculatory dysfunction. Of these, 32 (97%) agreed to interview and 15 participated. Participants interviewed had median age 34 years (range 24-66), 12 (80%) in a long-term relationship with median time from surgery 36 months (range 11-112). Three overarching themes were identified. The first reflected the value of RPLND despite ejaculatory dysfunction. The second illuminated the impact(s) of ejaculatory dysfunction closely mapped to life stage, with flow-on impacts to fertility, sex, psychological wellbeing and communication. The third reflected information needs. Fertility was a substantial source of concern for some participants. Ejaculatory dysfunction had no effect on sex for some, whilst for others, sex was less pleasurable. Some reported benefits. Few reported ejaculatory dysfunction challenged masculinity, confidence, or self-esteem.

Conclusions: Future research should examine interventions to reduce distress related to fertility, challenged masculinity and body image.

Implications for cancer survivors: Whilst most participants considered ejaculatory dysfunction to have little impact on their sexual function and relationships, some reported significant difficulties varying by life stage and relationship status.

Keywords: Ejaculation; Health-related quality of life; Survivor; Testicular cancer.