Our knowledge of cancer is always expanding. Researchers and healthcare professionals take the knowledge gained from research studies and use it to develop better practices that will help prevent, detect and treat testicular cancer, as well as improve the quality of life of men with testicular cancer.
The following information is a selection of research showing promise for testicular cancer.
Diagnosis
A key area of research activity involves developing better ways to diagnose and stage testicular cancer.
Noteworthy research includes:
- Ultrasound is a test commonly used in the diagnosis of testicular cancer. Austrian researchers recently reported that ultrasound is a useful way to look for small testicular tumours in the remaining, non-cancerous testicle during routine follow-up. This may lead to a higher rate of testicle-sparing surgery if cancer is found in the remaining testicle (BJU International, PMID* 19793379).
Prognostic factors
Prognostic factors that may help determine the outcome of the disease are being studied in testicular cancer. They can be used to predict the chances of recovery or of cancer coming back. Doctors may also use prognostic factors to help them make treatment recommendations.
Noteworthy research includes:
- A large study in the United States, called the Surveillance, Epidemiology and End Results (SEER) program, found new prognostic factors that may help determine prognosis in men with testicular cancer (Journal of Clinical Oncology, PMID 21300926).
- Men over the age of 40 have a less favourable prognosis.
- Non-Caucasian men, and men with a lower socio-economic status, who have non-seminoma testicular cancer have a less favourable prognosis.
- The number of lymph nodes removed with retroperitoneal lymph node dissection (RPLND) appears to be associated with prognosis in men with testicular cancer. Researchers have found that a higher number of lymph nodes removed during RPLND is associated with a lower chance that the cancer would come back (recur) (ASCO**, Abstract 4572; Urology, PMID 20299079).
Treatment
Researchers are looking for new ways to improve the treatment of testicular cancer. Advances in cancer treatment and new ways to manage the side effects related to treatment have improved the outlook and quality of life for many people with cancer.
Noteworthy research includes:
- A retroperitoneal lymph node dissection (RPLND) removes lymph nodes at the back of the abdomen and is most commonly done for early-stage non-seminoma testicular cancer. This procedure helps doctors accurately stage the cancer. It is also part of treatment because it removes lymph nodes that may contain cancer.
- A large incision in the abdomen is often made to remove the retroperitoneal lymph nodes (open RPLND). Surgeons are also now using laparoscopic RPLND, in which a laparoscope inserted through small incisions in the abdomen to remove lymph nodes, instead of making a large incision. Laparoscopic RPLND has been associated with shorter hospital stays and fewer side effects compared to open RPLND. Recent studies also suggest that laparoscopic RPLND has the same level of safety and effectiveness in removing lymph nodes that may contain cancer (BJU International,PMID 21631699; Journal of Endourology, PMID 20879859; European Urology, PMID 18722704; Journal of Urology, PMID 18707723).
- Researchers are studying robot-assisted laparoscopic RPLND as a way to remove the lymph nodes. The surgeon sits near the operating table and controls robotic arms to perform the operation through several small incisions in the person’s abdomen (European Urology, PMID 21420231).
- Some men are at high risk of having small, undetected areas of cancer that have spread outside the testicle. Those at risk include men whose tumours contain more than 30% embryonal type non-seminoma testicular carcinoma. Men with cancer that has spread into the lymph vessels of the tumour (lymphovascular invasion) are also at risk for undetected cancer outside the testicle. In some studies, RPLND has been an effective treatment for this group of men, especially when RPLND was performed before chemotherapy. However, more research is still needed to prove its effectiveness (Journal of Urology, PMID 19286227).
- One of the risks of RPLND is damage to the nerves that control ejaculation. Fertility can be a problem for men who have difficulty ejaculating or cannot ejaculate. Doctors have tried to overcome this complication by developing nerve-sparing techniques that try to preserve ejaculation by avoiding these nerves. Nerve-sparing techniques have been used with open RPLND. Recently, nerve-sparing laparoscopic RPLND techniques have been performed with excellent results (Urology, PMID 19022490; Journal of Urology, PMID 18707723). Some studies suggest that nerve-sparing laparoscopic RPLND should be performed whenever possible in men who wish to preserve their fertility (Journal of Cancer Survivorship, PMID 20602187).
- A phase III study compared 2 BEP-based chemotherapy regimens in men with testicular cancer. BEP is made up of bleomycin (Blenoxane), etoposide (Vepesid) and cisplatin (Platinol AQ). One regimen consisted of only BEP. The other regimen consisted of BEP and paclitaxel (Taxol), which is called T-BEP. Men who received T-BEP had better rates of progression-free survival than men who only received BEP (ASCO, Abstract 4509).
- A study found that men with stage I non-seminoma testicular cancer benefit from 1 course of adjuvant BEP chemotherapy. Men who received BEP after surgery reduced their risk of recurrent cancer by up to 90%. The men who benefited most from this treatment were those who had cancer cells in blood vessels or lymphatic vessels within the tumour (Journal of Clinical Oncology, PMID 19307506).
- Researchers are studying newcombinations of chemotherapy drugs, especially for men whose testicular cancer recurs after initial chemotherapy.
- The combination of paclitaxel, ifosfamide (Ifex) and nedaplatin (Aqupla) has shown promising results in a small study of men whose cancer did not respond to previous cisplatin-based treatment (ASCO, Abstract 257).
- Another small study found that the combination of paclitaxel, gemcitabine (Gemzar) and nedaplatin may be a second- or third-line treatment option for men whose cancer did not respond to previous treatment (ASCO, Abstract e15089).
- Research has found that men with late-stage testicular cancer are living longer as a result of better treatments. From 1973 to 2000, cure rates have risen from 23% to 81% in men with late-stage testicular cancer. These cure rates were used to calculate the “gain in life expectancy,” which is measured in years. A 24-year gain in life expectancy was found over this time period (Cancer, PMID 18393325).
Supportive care
Living with cancer can be challenging in many different ways. Supportive care can help people cope with cancer, its treatment and possible side effects.
Noteworthy research includes:
- Many men with testicular cancer are diagnosed at a young age, and their ability to father children in the future is often an important issue. Fertility problems and problems with sexual function can happen because of testicular cancer or its treatment. These problems can impact a man’s quality of life.
- Men who received 2–4 cycles of cisplatin-based chemotherapy for testicular cancer were followed for an average of 12 years to see how this treatment may have affected their paternity. The Norwegian study found that the chances of being able to father a child increased with decreasing cycles of cisplatin-based chemotherapy. However, men who had a higher number of cycles still had a good chance of fathering a child (European Urology, PMID 20395037).
- An American study found that men with testicular cancer were as likely to actually father a child as a group of similar men without testicular cancer. The study also found that men with testicular cancer had greater fertility distress and higher rates of fertility testing (Journal of Cancer Survivorship, PMID 20571931).
- Researchers are studying new ways to preserve a man’s fertility after cancer treatment. Some men with testicular cancer who have had chemotherapy may become infertile (not able to father a child) after the treatment. Testicular sperm extraction (TESE) is a technique used to collect sperm. TESE removes tiny pieces of tissue from the testicle. This tissue is examined for sperm cells. Any sperm cells found can be used immediately or frozen for future use. A study found that TESE was an effective way to preserve a man’s fertility after chemotherapy (Journal of Clinical Oncology, PMID 21402606).
- Sexual function has been reported to fluctuate during the first year following treatment for testicular cancer. After a period of one year, sexual function began to improve, according to a Dutch study. Among men who underwent treatment for testicular cancer, those in committed relationships tended to have better sexual functioning than single men. This finding highlights that single men may need more guidance and information regarding sexuality after treatment for testicular cancer (Psycho-oncology, PMID 19319832).
- Men treated with radiation therapy or chemotherapy have an increased risk of developing a second cancer (BJU International, PMID 21883828; Cancer, PMID 21480199).
- A Swedish study found that, among men who developed a second cancer, gastrointestinal tractcancers (such as stomach, colon or rectal cancer) occurred mainly after a seminoma. It also found that bladder cancers were more common after a non-seminoma (Annals of Oncology, PMID 20019089).
- C-reactive protein (CRP) is a protein found in the blood. CRP levels rise in response to inflammation, so CRP has been a useful marker of cardiovascular disease. Researchers are also using CRP to see if it is a potential marker of a second cancer in men with a history of testicular cancer (European Journal of Cancer, PMID 20832295).
- Testicular cancer is most common in male adolescents and young adults (15–29 years of age). These men have follow-up for many years after their diagnosis, which often includes imaging tests that expose them to radiation. Since radiation can sometimes cause cancer, Canadian researchers are studying lower-dose imaging tests, such as computerized tomography (CT) scans, to see if they are useful for follow-up and safer than the regular, higher-dose tests (ASCO, Abstract 4565).
- Cardiovascular disease, such as heart attack and congestive heart failure, develops in some men several years after treatment for testicular cancer. Cisplatin-based chemotherapy tends to be related to an increased risk of cardiotoxicity (damage to the heart) and cardiovascular damage (Annals of Oncology, PMID 21878427; Journal of Clinical Oncology, PMID 20855830; British Journal of Cancer, PMID 19455138). C-reactive protein (CRP) is a useful marker of cardiovascular disease. Researchers have found that CRP is helpful in finding cardiovascular disease in men with a history of testicular cancer (European Journal of Cancer, PMID 20832295).
- Survivors of testicular cancer tend to be prone to depression, nervousness, anxiety and a decreased quality of life.
- These symptoms may be related to the long-term side effects of treatment, such as infertility, neurotoxicity (damage to the nervous system) and decreased hormone levels (Journal of Affective Disorders, PMID 19656574; Acta Oncologica, PMID 19412812).
- Men with testicular cancer have higher rates of cognitive dysfunction (memory and concentration problems). Some studies suggest that cognitive dysfunction may be related to emotional distress and fatigue. Other studies suggest that it is a side effect of chemotherapy. People who have undergone chemotherapy commonly complain of trouble with memory and concentration (Journal of Psychosomatic Research, PMID 21511070; Journal of the International Neuropsychological Society, PMID 19203434; Acta Oncologica, PMID 17934892). It is important that doctors monitor survivors of testicular cancer for issues related to their mental health and educate them about the possibility that such problems may develop.
- There is some evidence that men who have had chemotherapy as a treatment for testicular cancer may be prone to language problems. A study in Sweden found that men with testicular cancer who had 5 or more cycles of cisplatin-based chemotherapy were more likely to use incorrect words when speaking or were unable to complete sentences compared to men with testicular cancer who did not undergo chemotherapy (Acta Oncologica, PMID 21851186).
- A recent study has found that men with testicular cancer who were treated with cisplatin-based chemotherapy were at risk for decreased lung function several years after having treatment (Journal of Clinical Oncology, PMID 19414680). These findings support the need for long-term follow-up care for testicular cancer survivors.
*PMID is the National Library of Medicine PubMed abstract identity number.
**ASCO is the American Society of Clinical Oncology.
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