July 21, 2008

Testicular Cancer Options Debated <> Research Supports 1 Dose of Chemo After Surgery


Testicular cancer is a rare beast.

It's relatively easy to detect. And it's very treatable. It's also one of the few cancers that can be cured.

Yet specialists still debate the best way to continue treatment once the cancerous testicle is surgically removed.

"If you ask a surgeon, they might say chemotherapy or a radiologist might say radiation and a medical oncologist will then say let's do either one round of chemotherapy or just observation," said Gil Rodrigues, a medical oncologist with the Milwaukee-area Oncology Alliance.

"But the real issue, since we know it's curable, is how can we minimize toxicity during treatment," he said.

At a meeting of cancer specialists last month in Chicago, researchers showed that a single dose of chemotherapy was just as effective -- and less toxic -- as radiation for patients with early- stage testicular cancer.

The findings were based on data from nearly 1,500 European patients who were randomly assigned to receive either a single dose of the chemotherapy drug carboplatin over one hour on an outpatient basis or a course of daily radiation therapy for two or three weeks. Radiation treatment is the standard of care in the United States.

"Personal preference is becoming a more important factor in determining the best treatment for patients with testicular cancer. We've also seen this in prostate cancer, where there are a number of equally strong treatment options," said Tim Oliver, the professor emeritus of medical oncology at St. Bartholomew's Hospital in London who presented the findings. "This study establishes surgery followed by carboplatin chemotherapy as a safe new alternative for patients who have early-stage (testicular cancer) and would prefer a treatment that lasts a shorter period of time."

However, more long-term follow-up is needed to verify the safety of single-dose chemotherapy treatment, he said.

Surveillance an option

"The ways to treat after removal of the testicle has been controversial and will always be," said Nancy Davis, medical oncologist and testicular cancer specialist at the Froedtert & Medical College of Wisconsin Clinical Cancer Center in Wauwatosa.

"Surveillance is also an option after the testicle is removed, but it's a very rigid schedule," she said.

"You need a man who is very reliable or . . . conscientious about their health . . . But we're talking about a group that's generally healthy and don't see their doctors regularly anyway."

The American Cancer Society estimates there will be more than 8,000 new cases and nearly 400 deaths from testicular cancer this year. This disease occurs most often in men between the ages of 20 and 39.

There are about 140,000 men who have survived testicular cancer in the U.S., the group says.

"It's the ideal success story," said Glenn Liu, an assistant professor of medicine and medical oncologist at the University of Wisconsin Carbone Comprehensive Cancer Center in Madison.

"However, 80 percent of men would be cured without doing anything after surgery," he said. "So if you start treating everyone after surgery, you would be over-treating the majority of men."

Picking treatment hard

Typical treatment for testicular cancer can include surgery, radiation therapy, chemotherapy or various combinations.

Thus, the decision on best treatment for testicular cancer is difficult, especially since there are so many drugs that have been shown to eradicate the disease, Rodrigues said.

Doctors may grapple over which option to use, particularly since many of the long-term side effects aren't clearly understood, he said.

A Swedish study also presented at the Chicago meeting found that patients needing more than the four cycles of chemotherapy were at risk of developing both neurological and cognitive long-term side- effects, such as producing similar but incorrect words and other language difficulties.

And it's been clearly shown that certain treatments for testicular cancer can cause permanent infertility. For this reason, some patients choose to freeze their sperm before treatment so they can have it for later use.

Like other cancers, the exact cause of testicular cancer is unknown. However, studies have found that men are more likely to develop the disease if they have an undescended testicle, a congenital abnormality, family history or if they've had testicular cancer before.

Self-exams encouraged

Doctors typically encourage their male patients to do testicular self-exams and to report if they have a painless lump or swelling in a testicle, Liu said.

"Guys, like girls, need to know their bodies so they know when something is wrong," Davis said.

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