London HUB - Changing the Narrative for Testicular Cancer Patients Through Innovation and Collaboration

Changing the narrative for testicular cancer patients through innovation and collaboration.

Author: Elsie Mensah, Consultant Urologist, GSTT Daghni Rajasingham, Deputy medical director, GSTT Maj Shabbir, Consultant Urological Surgeon, Lead for Andrology, male infertility and genitourinary reconstruction, GSTT

Trust: GSTT

Guys Urology has a Friday educational meeting and one of the unique aspects is that consultants who have reached their 10 year anniversary are invited to reflect on their career and future aspirations. Maj Shabbir’s ten-year talk reflected on building the andrology unit including, male infertility, a sickle cell priapism service and the testicular Onco-tese service, which has radically changed practices for testicular cancer patients.

October 2022

Maj Shabbir had an encounter with a testicular tumour patient and due to his background in fertility, decided to evaluate this patient’s semen parameters, though this was not standard practice at the time. He found that this patient was azoospermic (absent sperm in ejaculate) and this led to a series of events that highlighted to Maj the depth of this problem and the need for the uro-oncology community to serve these patients better.

He had already successfully established a micro-tese service at guys. This is a procedure for infertile men with low or absent ejaculated semen where areas of active sperm production are identified by examining the testicle under a microscope in theatre. He had high success rates in identifying sperm which could subsequently be used by these families in assisted reproduction techniques such as IVF. He led research work to retrospectively review tumour bearing testicles that had been removed in the past and showed >60% of these also contained areas of sperm production which could have been utilised to preserve fertility options for these men at the time of their surgery for testicular cancer. This procedure in tumour bearing testicles is called onco-tese.

October 2022

Collaboration was essential to the success of the onco-tese service as colleagues from andrology, embryology and gynaecology needed to work at relatively short notice to meet the oncological timeframes for these patients.

Beyond GSTT however, real leadership has been required to ensure that testicular cancer patients across the country also have these fertility assessments and options. Education has been key. This work has been presented widely in local, European and international meetings and formed part of the basis for which the European Association of Urology amended guidelines to include a recommendation for semen parameters to be assessed in patients diagnosed with testicular cancer. There are further recommendations for appropriate patients to be offered Onco-tese, something Maj and indeed GSTT can be proud of.

The plan for the future is to develop nominated Onco-tese centres nationally to ensure that every patient has access to a local service thus ending the postcode lottery.

October 2022

He remarks that GSTT is a place where innovative ideas which improve patient care are encouraged and nurtured. 'People line up to help’. Tips for clinicians keen to innovate and develop services is to have a clear plan, identify which individuals or teams are required and keep it personable - a face to face conversation often achieves more than several emails.

Finally, sharing positive outcomes helps to keep the team enthused. The team have a growing wealth of feedback, compliments and baby pictures from patients who have been helped through the range of fertility preservation options that this team is able to provide.