Monitoring Stage I Testicular Cancer Is a Safe Option After Surgery

ASCO Annual Meeting
May 15, 2013

Results from a long-term study on stage I seminoma show that surveillance, or watching for a cancer recurrence (cancer that comes back after treatment), is a safe option for most men. Seminoma is a type of testicular cancer that is generally slow growing and makes up about half of all testicular cancer diagnoses. In stage I seminoma, the tumor has not spread to the lymph nodes (tiny, bean-shaped organs that fight infection) or other parts of the body. Surgery is usually the first treatment given. Surveillance includes physical examinations and imaging and blood tests for five years. In the United States, about half of patients are monitored for a recurrence and the other half receives either radiation therapy or chemotherapy to help prevent a recurrence.

For this study, researchers used a nationwide database in Denmark to collect information from 1,822 men with stage I seminoma who were followed as part of a five year surveillance program to monitor for a cancer recurrence after surgery. Overall, 355 of these patients, or about 20%, had the cancer come back within about 15 years. Then they received chemotherapy, radiation therapy, or further surgery. Researchers found that more than 99% of these men lived at least 10 years after the original treatment. In other words, out of every 1,000 men who received surveillance after surgery, four died within 10 years after the original treatment.                                                                                                                       

Researchers also found that certain factors are linked with a higher risk of recurrence, such as a tumor larger than 1.5 inches, spread to blood or lymphatic vessels, and higher levels of a blood marker called human chorionic gonadotropin.

What this means for patients

“With this study, we have solid proof that surveillance is safe and appropriate for most patients with this particular cancer,” said Mette Saksø Mortensen, MD, a PhD student in the Department of Oncology at the Copenhagen University Hospital in Denmark. “We also identified key factors that predict the risk of a recurrence, which can help us know which patients may need therapy after surgery instead of surveillance. However, in general, all patients with stage I seminoma can safely be followed on a surveillance program.” Although surveillance can seem like a difficult choice for patients, it can help patients maintain their quality of life by avoiding the side effects of further treatments, such as increased risk of another type of cancer, especially when, in this situation, these treatments are unlikely to lengthen a man’s life.

Questions to Ask Your Doctor

  • What type and stage of testicular cancer do I have?
  • What are my treatment options?
  • Do you recommend additional treatments after surgery?
  • What is the chance that the tumor will come back after treatment?
  • Is surveillance recommended for me? If so, what tests will I need and how often?
  • If the cancer does come back, what are the next steps?

For More Information

Guide to Testicular Cancer

What to Know: ASCO’s Guideline on Tumor Markers for Testicular Cancer and Extragonadal Germ Cell Tumors in Teenage Boys and Men