Usage of Testicular Cancer Markers Too Limited, Say Researchers

A standard part of testicular cancer care isn’t used in more than half of all patients who have the condition, researchers have found.

Doctors generally rely on a series of three serum-based tumor markers for testicular cancer, since these are helpful with diagnosis, prognostication and surveillance for disease recurrence following treatment.

Reviewing 4,700 testicular cancer cases however, the researchers found that a combination of two of these tumor markers were used less than half of the time, while all three tumor markers were measured in just 16 percent of the cases.

The study authors also discovered that only 45% of cases used the tumor markers AFP (alpha fetoprotein) and HCG (human chiorionic gonadotrophin), with a third tumor marker, LDH or lactate dehydrogenates, used in combination with the other two, just 16% of the time. These results are reported in Urologic Oncology, Seminars and Original Investigations.

"Tumor markers play a central role in showing physicians how a patient is responding to treatment and whether the disease has recurred," says lead author Scott M. Gilbert, M.D., clinical lecturer in the University of Michigan Department of Urology. "We were extremely surprised by the low rates of usage."

Dr. Gilbert conduct regular checks on all three markers in their patients, because if the markers stay elevated after therapy, it shows the cancer remains; or if the markers begin to rise during the observation period following successful treatment, this too shows the cancer has returned.

One explanation for the low rates of marker usage could be poor documentation in medical records, since incidents of tumor marker use were not always recorded, says senior author Brent K. Hollenbeck, M.D., M.S., assistant professor in the U-M Department of Urology. "Even if it isn’t a problem related to the care of the patients, it is a quality problem at the medical centers that are not recording the data properly. Either way, major improvements need to occur," he says.

But other data in the study suggest that the reporting of tumor marker use may not be the problem. Using the data from the Surveillance, Epidemiology, and End Results (SEER) program, the researchers found substantially more documentation of PSA use in prostate cancer patients compared to the testicular cancer tumor markers. That information supports the notion that recording may not be the problem, but that the use of testicular cancer markers is in fact very low.

Source: University of Michigan

Infertility and Testicular Cancer Linked, Says Study

University of California, San Francisco researchers have found that men with a history of infertility have a markedly increased risk of subsequently developing testicular cancer. The purpose of the study was to assess testicular cancer in infertile men usingna cohort study methodology.

More than 51,000 couples, drawn from 15 California infertility centers during the period 1965 and 1995, were evaluated for infertility. Male subjects’ medical records were linked to the California Cancer Registry, the cumulative Surveillance Epidemiology and End Results Registry (SEER) for the State of California. Cancers preceding infertility were excluded from analysis, and the incidence of testicular cancer in this cohort was compared to age-matched men from the general population.

The study found that men from infertile couples were 60% more likely to develop testicular cancer than other men (standardized incidence ratio 1.695% confidence interval 1.2 to 2.2). This risk was relatively constant across all age strata.

Source: UroToday

Second Round High Dose Chemo May Cure Testicular Cancer

Physicians from Indiana University report that increasing the dosage of anticancer drugs after the failure of first-line chemotherapy may lead to more succesful outcomes for men with testicular cancer.

The report published in the New England Journal of Medicine states that a considerable number of male patients with germ cell tumor are cured when they are treated with a second round of high dosage chemotherapy after the first round of chemotherapy has failed.

Unusual sensitivity of testicular cells to anticancer medicines is assumed to be behind these successful treatments. This treatment, however, cannot be extended to other types of cancers.