Early stage testicular cancer - surveillance is best follow-up strategy


Early stage testicular cancer - surveillance is best follow-up strategy

A long-term study of men with stage I seminoma, a common form of testicular cancer, suggests that surveillance for cancer recurrence, rather than additional chemotherapy or radiation therapy, is sufficient for the vast majority of patients who have undergone successful surgery for their cancer.

In a new long-term study conducted in Denmark, researchers analyzed a national clinical database and found that 99.6% of patients who only underwent surveillance (following a successful surgery) were alive after 10 years of being diagnosed with testicular cancer.

Surveillance means carrying out routine CT scans, physical exams, chest X-ray exams, and blood tests for a period of five years after surgery.

In some countries, such as Denmark (where the study took place), the preferred follow-up strategy is surveillance alone. In the U.S. half of patients undergo either radiotherapy or chemotherapy as follow-up treatment, while the other half only receive surveillance.

There has been a recent increase in the number of patients undergoing surveillance alone in the U.S., a trend that will likely continue following this new finding.

Treatment options such as chemotherapy or radiotherapy can cause very harmful side effects, including a higher risk of secondary cancers (such as leukemia). Therefore, other follow-up strategies that don't incur such drastic risks, such as surveillance alone, are preferred.

Mette Saksø Mortensen, MD, a PhD student at the Department of oncology at the Copenhagen University Hospital in Copenhagen, Denmark, said:

"To our knowledge, this study is the largest to address this issue in patients with stage I seminoma, and with the longest follow-up. Now we have solid proof that surveillance is safe and appropriate for most patients with this particular cancer.

We also characterized key prognostic factors for relapse, which can help us identify high-risk patients who may need adjuvant therapy instead of surveillance. However, in general, seminoma stage I patients can safely be followed on a surveillance program."

A total of 1,822 men with stage I seminoma, who underwent successful surgery were followed on a five year surveillance program. The researchers were able to follow the patients for an average of 15.4 years.

19.5 percent of the patients experienced a relapse, of whom 216 received radiotherapy while 136 received chemotherapy and only 3 underwent surgery.

The 10-year-cancer-specific survival rate was 99.6 percent, which translates into four men dying out of every 1,000 who underwent surveillance alone.

The risk of relapse increased among patients whose tumor size was bigger than 1.5 inches and spread to lymphatic vessels or blood, as well as those whose levels of a blood marker called human chorionic gonadotropin were high.

Even though testicular cancer is quite rare among the general population, it is the most common solid tumor among young men. Approximately 4,000 people will be diagnosed with stage I seminoma this year in the U.S.

ASCO President-Elect Clifford A. Hudis, MD, said:

"This important study is one of several recent reminders that sometimes "less is more‟ in patient care. Opting for surveillance spares patients, most of whom are young men, from the harmful side effects of chemotherapy and radiation without diminishing their chances for a long and healthy life."

Scientists at UC Davis found that frequent CT scanning for testicular cancer surveillance was associated with secondary malignancies.

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Section Issues On Medicine: Medical practice