Stage 0 Testicular Cancer
Among men diagnosed with an invasive testicular germ cell tumor (stages 1–3), 0.5% to 1.0% will present with tumors in both testes, and another 1% to 2% will develop a subsequent invasive germ cell tumor in the contralateral testis.[1-3] Death from metachronous contralateral germ cell tumors is rare. One study of 29,515 U.S. men with testicular germ cell tumors who were diagnosed between 1973 and 2001 reported that 287 men developed a metachronous contralateral testis cancer, one of whom died. As a result, there is limited rationale for performing biopsies to search for testicular intraepithelial neoplasia (TIN) in men diagnosed with invasive testis cancer.
If biopsies of the contralateral testis are performed in men with testis cancer, 4% to 8% of men will be found to have TIN in the contralateral testis. When it is diagnosed, the treatment is typically radiation therapy (18 Gy–20 Gy), surveillance, or orchiectomy. Men undergoing radiation therapy or orchiectomy will subsequently be sterile. Men undergoing orchiectomy will also be hypogonadal as will many men undergoing radiation therapy.
- Radiation therapy for TIN is associated with a low risk of relapse. One study of 122 patients with TIN treated with 18 Gy to 20 Gy of external-beam radiation therapy reported three relapses (2.5%).
- Surveillance with annual transscrotal ultrasounds and monthly self-examinations are also options for men with TIN. Approximately one-half of the TIN cases will progress to invasive germ cell tumors with a median time to progression of roughly 3 years.
- Chemotherapy does not appear to be very effective at preventing the development of invasive testicular germ cell tumors. One series reported progression to invasive cancers in 10 of 30 patients treated with two cycles of bleomycin, etoposide and cisplatin (BEP); the same progression was found in 7 of 51 patients treated with three or more cycles of BEP; 2 of 15 patients treated with carboplatin also showed a progression to invasive cancers.[4,5]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with malignant testicular germ cell tumor. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
- Schaapveld M, van den Belt-Dusebout AW, Gietema JA, et al.: Risk and prognostic significance of metachronous contralateral testicular germ cell tumours. Br J Cancer 107 (9): 1637-43, 2012. [PUBMED Abstract]
- Tabernero J, Paz-Ares L, Salazar R, et al.: Incidence of contralateral germ cell testicular tumors in South Europe: report of the experience at 2 Spanish university hospitals and review of the literature. J Urol 171 (1): 164-7, 2004. [PUBMED Abstract]
- Fosså SD, Chen J, Schonfeld SJ, et al.: Risk of contralateral testicular cancer: a population-based study of 29,515 U.S. men. J Natl Cancer Inst 97 (14): 1056-66, 2005. [PUBMED Abstract]
- Dieckmann KP, Wilken S, Loy V, et al.: Treatment of testicular intraepithelial neoplasia (intratubular germ cell neoplasia unspecified) with local radiotherapy or with platinum-based chemotherapy: a survey of the German Testicular Cancer Study Group. Ann Oncol 24 (5): 1332-7, 2013. [PUBMED Abstract]
- Kleinschmidt K, Dieckmann KP, Georgiew A, et al.: Chemotherapy is of limited efficacy in the control of contralateral testicular intraepithelial neoplasia in patients with testicular germ cell cancer. Oncology 77 (1): 33-9, 2009. [PUBMED Abstract]