Testicular Cancer Cure Poses Problems
Feb. 28, 2002 -- Testicular cancer is a young man's disease, and it is almost always curable when caught early. But there is new evidence that the lifesaving treatments can cause life-threatening health problems decades later.
Cure rates are now higher than 90% for most types of testicular cancer, and they approach 50% for even the most advanced, poor-prognosis cases. For this reason, the emphasis is shifting to the long-term well-being of testicular cancer survivors, and many experts are concerned that overtreatment is putting their future health at risk.
Two European studies published in the current issue of the journal Annals of Oncology found that a high percentage of testicular cancer patients treated with chemotherapy had abnormal heart and kidney function. Kidney function was also diminished among men receiving only radiation treatment.
The studies were done about 15 years after men in their 20s and 30s had been treated for testicular cancer. Although many had conditions that could lead to heart disease or kidney failure, few of the men -- who were mostly in their 40s -- had any evidence of disease.
"We don't know a lot about the long-term consequences of these therapies," Sophie Fossa, MD, tells WebMD. "But it is likely that within the next two decades -- when these survivors will be in their 60s -- that some will be facing kidney failure because of them."
Fossa and colleagues at The Norwegian Radium Hospital in Oslo evaluated kidney function in 85 men who had received various treatments for testicular cancer. They found that 20% to 30% of men who received radiation and chemotherapy had decreased kidney function.
In a separate study of 32 men who receive chemotherapy, researchers from Germany's University of Essen found that one-third had decreased heart function a decade or more after treatment. More than 80% had high cholesterol and one in four had high blood pressure.
Too Much of a Good Thing
Patients with early-stage disease confined to the testicles or lymph nodes of the abdomen always receive surgery to remove the cancerous testicle, but there are various treatment options after this. Many men also receive radiation or surgery to remove lymph nodes. But some forgo further treatment in favor of a watch-and-wait approach. Chemotherapy is largely reserved for men whose cancers have spread.
Fossa says she believes that most men with early testicular cancers are overtreated, especially if they have tumors known as seminomas, considered to be less aggressive cancers. Seminomas account for about 40% of all testicular cancers.
"I think we overtreat 80% of stage I seminoma patients," she says. "They don't need radiotherapy, but they are getting it. These patients can be watched very carefully and they will do fine. But that is not a very popular notion in the United States."