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Testicular Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - 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.[1,2,3] 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.[3] 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.[4]

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Treatment options:

  1. 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%).[4]
  2. 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.[4]
  3. 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.

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