Surgery Linked with Outcomes with Late Relapse of Metastatic Testicular Cancer

Surgery Linked with Good Outcomes for Patients with Late Relapse of Metastatic Testicular Cancer

Patients who experience a cancer relapse more than two years after treatment for metastatic nonseminomatous testicular cancer can achieve good survival rates if the cancer relapse can be treated surgically. These results were published in the journal BJU International.

Cancer of the testicles is the most common cancer in men 15 to 34 years old. The testicles are part of the male reproductive system and are located inside the scrotum (a loose sac of skin that lies directly under the penis). Sperm and male hormones are produced in the testicles.

Testicular cancer is broadly divided into two different types-seminoma and non-seminoma-based on the appearance of cells under the microscope. Non-seminomas are, in general, more difficult to cure than seminomas. Non-seminoma cell types include: embryonal carcinoma, teratoma, yolk sac carcinoma, choriocarcinoma, and various combinations of these cell types.

Many men diagnosed with metastatic nonseminomatous testicular cancer will be cured with chemotherapy. Some of these men, however, will later experience a cancer recurrence. Cancers that recur more than two years following initial chemotherapy may differ from cancers that recur earlier, and may require different treatment approaches. There is some evidence, for example, that late relapses may be less sensitive to chemotherapy.

To describe the experiences of men who have a cancer relapse more than two years after the successful treatment of metastatic nonseminomatous testicular cancer, researchers in the UK reviewed the medical records of patients diagnosed between 1980 and 2004. Among 405 men treated with chemotherapy (with or without surgery) for metastatic nonseminomatous testicular cancer, 329 experienced a complete disappearance of detectable cancer following treatment. The frequency of late relapse (relapse more than two years after initial treatment) was assessed in these 329 men.

  • A late cancer relapse occurred in 20 of the 329 men.
  • Most of the late relapses (65%) did not cause symptoms and were detected by routine imaging or blood tests.
  • For half the patients, late relapse occurred more than nine years after initial treatment.
  • In 15 out of 20 men with late relapses, the relapse was treated with surgery alone. Half of these men have now been followed for more than three and a half years, and 14 of the 15 are still alive.
  • Five men with late relapses were not considered to be candidates for surgery and were treated initially with chemotherapy. Two of these men are still alive.

The researchers conclude that when surgery is feasible, it appears to produce good outcomes in the treatment of late relapses of metastatic testicular cancer.

Reference: Geldart TR, Gale J, McKendrick J, Kirby J, Mead G. Late Relapse of Metastatic Testicular Nonseminomatous Germ Cell Cancer: Surgery is Needed for a Cure. BJU International. 2006;98:353-358.

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