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Thread: Can Prostate Cancer Cause Testicular Cancer?

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    Distinguished Community Member gpawelski's Avatar
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    Default Can Prostate Cancer Cause Testicular Cancer?

    Justin Harman, M.D.
    Urological Oncologist

    Over the past four decades, testicular cancer has equaled - and probably surpassed - Hodgkin's disease as the number one cancer in young men between the ages of 15 and 34. Overall, it is still a rare neoplasm; 1 percent of all male cancers are testicular, with an incidence of two per 100,000 in the adult male population. In teenagers and young men, however, the incidence may be as high as one in 10,000, and it may be slowly increasing. The American Cancer Society estimates by 1999, there will be about 7,400 new cases of testicular cancer that will be diagnosed in the United States, and an estimated 300 men will die of testicular cancer.

    Men with undescended testicles are at greatest risk for testicular cancer. About 10 percent of all men with testicular cancer have a history of cryptorchidism or an undescended testicle. Men with undescended testicles have 10 to 40 times the risk of developing a malignancy - one tumor per every 2,000 undescended testes.

    For unknown reasons, Caucasians are four times more likely than non-Caucasians to have testicular cancer. The vast majority of testicular cancers in young people are seminomatous. If the tumor is found early and treated by surgical removal of the testis, possibly in combination with radiation, the prognosis is excellent. In fact, with the success rates in early-stage seminomas rapidly approaching 100 percent, oncologists now describe testicular cancer as a curable neoplasm.

    The most common types of testicular cancer are seminoma and nonseminoma. Seminomas make up about 40 percent of all cases. These are more sensitive to radiation treatment. Nonseminomas are actually a group of cancers. They include choriocarcinoma, embryonal carcinoma, teratoma and yolk sac tumors. Each of these major testicular cancers grow and spread differently and are treated differently.

    Ninety-five percent of all primary testicular tumors arise from germinal elements. Nongerminal elements, Sertoli and Leydig cells, account for roughly 5 percent of all primary testicular tumors.

    Germinal neoplasms are traditionally divided into seminomas and a variety of other types of germinal neoplasms, known collectively as nonseminomatous germ cell tumors. A number of prognostic classification schemes are in use for metastatic nonseminomatous testicular cancer and primary extragonadal nonseminomatous germ cell cancers treated with chemotherapy.

    Causes

    The cause of testicular cancer is not known.

    Symptoms

    Testicular cancer can cause a number of symptoms. Men should look for these warning signs:

    lump in either testicle
    enlargement of a testicle
    a feeling of heaviness in the scrotum
    a dull ache in the lower abdomen or the groin
    a sudden collection of fluid in the scrotum
    pain or discomfort in a testicle or the scrotum
    enlargement or tenderness of the breasts.

    These symptoms are not sure signs of cancer. They may also be caused by other conditions. However, it is important to see a doctor if any of these symptoms lasts as long as two weeks. Early diagnosis of testicular cancer is especially important, because the sooner cancer is found and treated, the better a man's chances are for complete recovery.

    Treatment

    Testicular cancers can be treated with surgery, radiation therapy and chemotherapy. The doctor may use one method or a combination of methods. Often, the patient is referred to medical centers that specialize in testicular cancer treatment.

    Surgery

    In most cases, surgery is done to remove the testicle. Sometimes, it may also be necessary to remove lymph nodes in the abdomen. In addition, tumors that may have spread to other parts of the body may be partly or entirely removed by surgery.

    Radiation Therapy

    In radiation therapy (also called x-ray therapy, radiotherapy, cobalt treatment or irradiation), high-energy rays are used to damage cancer cells and stop their growth. Like surgery, radiation therapy is a local treatment; it affects only the cells in the treated area. Patients usually receive radiation therapy in an outpatient clinic.

    Seminomas are highly sensitive to radiation. Following surgery, men with seminomas generally have radiation therapy to their abdominal lymph nodes.

    Nonseminomas are not sensitive to radiation. Patients with this type of cancer need other types of treatment.

    Chemotherapy

    The use of drugs to treat cancer is called chemotherapy. Anticancer drugs are recommended when there are signs that the cancer has spread. Also, chemotherapy is sometimes used if the doctor suspects that undetected cancer cells may remain in the body after surgery or radiation. The use of anticancer drugs following surgery for an early stage of cancer is known as adjuvant therapy.

    Chemotherapy may be given by mouth or by injection into a muscle or blood vessel. Chemotherapy is a systemic treatment - the drugs enter the bloodstream and reach cells all over the body. Depending on the specific drugs and the patient's general condition, chemotherapy may be taken as an outpatient, at the doctor's office or at home. Sometimes, the person must be hospitalized for a period of time so that the effects of the treatment can be watched.
    Gregory D. Pawelski

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    Distinguished Community Member gpawelski's Avatar
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    Default Advanced therapy offers cure for relapsed cancer patient

    Testicular cancer patients who do not respond to traditional therapy can be cured with high-dose chemotherapy and a stem cell transplant, according to an Indiana University School of Medicine report in the July 26, 2007 issue of the New England Journal of Medicine.

    About 90 percent of testicular cancer patients respond to traditional therapy, which involves multiple courses of cisplatin, first used successfully in the treatment of this disease by Lawrence Einhorn, M.D., at Indiana University Cancer Center in the early 1980s. That course of therapy turned a disease from a mostly fatal cancer into one of the more curable forms of cancer for men, who typically are in their 20s when diagnosed with testicular cancer.

    It is rare for the NEJM to carry a retrospective study from a single institution that is not a randomized study. This review looks at the outcome of 184 patients with metastatic testicular cancer. Dr. Einhorn and colleagues demonstrated that the disease is potentially curable with a high dose chemotherapy and stem cell transplant using cells harvested from the patient before the initial chemotherapy infusion.

    The patients received carboplatin chemotherapy at five times the dosage administered to men receiving initial therapy. A side effect of the high dosage is a reduction of blood cells so a stem cell transplant is given to replenish the body's immune system through a process similar to a blood transfusion. Three to four weeks later the entire process is repeated.

    The message for patients is that through research, diligence and new technologies there is hope,¯ said Dr. Einhorn, professor of medicine at the Indiana University Melvin and Bren Simon Cancer Center and the lead author of the study. The bar is steadily being raised and more patients are being saved.¯

    This review confirms that high-dose chemotherapy combined with a stem cell transplant can provide a cure for a group of patients with relapsed testicular cancer,¯ said Rafat Abonour, M.D., associate professor of medicine in the division of hematology/oncology and associate dean for clinical research at the IU School of Medicine.

    Although the number of relapsed testicular cancer patients is small, the IU Simon Cancer Center treats a majority of them. As a leader in this treatment, the researchers were able to collect the necessary data for the NEJM retrospective.

    For the patients each year who are treated with this therapy, there is renewed hope. This is new medicine and it tells patients that cures are on the horizon, said Stephen D. Williams, M.D., director of the IU Simon Cancer Center and a co-author of the paper.
    Gregory D. Pawelski

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    Default Treatment not testicular cancer poses greatest risk to survivors' long-term health

    Testicular cancer survivors can face an increased risk of long-term illness, not because of the malignancy, but the highly effective treatment they receive, according to a study in the urology journal BJUI.

    Researchers from the Norwegian Radium Hospital at the University of Oslo found that the number of problems faced by survivors are higher than generally thought, because clinicians only report those that are life-threatening or require medical intervention. Awareness of this discrepancy has led to a greater focus on patient-reported outcomes.

    The research review, part of a November 2009 BJUI special issue on testicular cancer, shows that as many as a quarter of survivors develop long-term neurological, hearing and circulation problems and they are twice as likely to develop a secondary cancer. On a more positive note, up to 80 per cent who attempt to become fathers after treatment are successful.

    "Patients can suffer considerable mental distress after having one testicle removed due to cancer, but this gradually decreases with treatment" says lead author Professor Sophie D Fossa.

    "Gastrointestinal side-effects are common during both chemotherapyterm and radiotherapy and chemotherapy carries added risks like infections and blood clots. Long-term problems include secondary cancers, heart problems, and conditions related to lower hormone levels.

    "We believe that the best way to reduce the short and long-term health of survivors is to reduce the risk, by smoking cessation, physical activity and weight reduction, and to provide adequate follow-up for patients who could develop life-threatening toxicity."

    Key findings from the review, which covered 40 studies published between 1990 and 2008, included:

    * About 80 per cent of men who have one testicle removed continue to produce sperm, often at reduced levels, and although men are advised to freeze their semen before treatment, less than 10 per cent use their frozen samples later on.

    * Pulmonary complications can arise in men who receive the drug bleomycin before larger surgical procedures, particularly if they are aged 40 or over.

    * Radiotherapy can cause short-term nausea, vomiting and lethargy, but side-effects tend to decrease two to four weeks after therapy.

    * Cisplatin-based chemotherapy can damage the sensory nerves in 10 to 30 per cent of patients and 20 per cent of survivors complain of impaired hearing and tinnitus.

    * Most acute drug toxicity problems tend to resolve themselves, or decrease, in the first year, but long-term problems pose greater issues. Despite this, many patients are only monitored by their consultant for five to ten years, after which they may or may not be regularly seen by primary care professionals.

    * Survivors are up to 1.8 times more likely to develop a secondary cancer, particularly solid malignancies below the diaphragm. The introduction of cisplatin-based chemotherapy, and a gradual reduction in radiotherapy, does not appear to have reduced the secondary cancer risk. But it appears to reduce the risk of cancer developing in the remaining testicle.

    * Avoiding mediastinal radiotherapy has reduced the risk of chronic heart complications, but death rates are still slightly increased by infra-diaphragmatic radiotherapy. In addition, the chemotherapy drug cisplatin can cause inflammation of the endothelial cells, leading to premature thickening of the coronary arteries.

    * About 20 per cent of survivors have already suffered irreversible hypogonadism, where the testes produces little or no sex hormone, and reduced fertility before their cancer is diagnosed.

    * Removal of lymph nodes in the abdomen can lead to dry ejaculation in some patients and infra-diaphragmatic radiotherapy and chemotherapy can cause temporary reductions in fertility.

    * Surprisingly, survivors report similar health-related quality of life to age-matched controls. However these measures do not cover body image and masculinity, issues that have been inadequately researched. It is suggested that survivors adapt to their new situation and take their cancer into account when rating their quality of life.

    * Anxiety levels are increased and are significantly associated with young age, peripheral neuropathy, economic problems, alcohol problems, sexual problems, fear of reoccurrence and having been treated for mental problems. Findings on depression are contradictory, but links between higher levels of depression and unhealthy lifestyles, particularly smoking, need urgent investigation.

    * About 17 per cent of survivors suffer chronic fatigue, almost twice the normal population, and this is associated with a wide range of factors, including older age, greater economic and sexual problems and poorer physical and mental health.

    * Sexual functioning is similar to age-matched controls, possibly because survivors adapt to their post cancer life. However survivors who have had the lymph nodes removed in their abdomen can experience more ejaculation problems.

    Work is important for survivors' health-related quality of life and, at least in Norway, they have the same living conditions, job stress and work engagement as age-matched controls, despite their poorer physical work ability.

    "Current patients with testicular cancer should be informed about the risk of short-term and particularly long-term side-effects of their highly effective treatment" concludes Professor Fossa.

    "It is important to focus on reducing risks through healthy lifestyle choices and consider important issues like preserving future fertility.

    "We would also like to see screening guidelines developed to ensure that the long-term side-effects are diagnosed and treated as early as possible."
    Gregory D. Pawelski

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    Distinguished Community Member gpawelski's Avatar
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    Default Routine testicular self examination: it’s time to stop

    At the same time, another “personal view” published in the BMJ by a UK physician, Keith Hopcroft, states, “Routine testicular self examination: it’s time to stop.” Excerpt:

    What do Robbie Williams and the Leicester Tigers rugby team have in common? Answer: testicles. Plenty of them. Enough cojones, in fact, to be leading lights in testicle cancer awareness. And they’re not alone. We are regularly bombarded by celebrity exhortations to be “testicle aware,” typically via some attention (and testicle) grabbing stunt.

    The specific message that cancer charities and men’s health tub thumpers ram home is that any self respecting bloke should regularly examine his testicles. Or grope his gonads. Or caress his crown jewels. Or whatever the prevailing vernacular might be—so long as it sounds non-threatening and wacky.

    It’s easy for the profession and the public to get carried away with earnest health promotion dressed up as fun and assume that routine testicular self examination is self evidently A Good Thing. The trouble is, it isn’t. It’s an activity based purely on well meaning whimsy, with the potential to do harm.

    There is no good evidence that routine testicular self examination is of any benefit. Nor will there ever be: a study of adequate power would require millions of men, simply because testicular cancer is so rare. This fact is distorted by all the well meaning evangelism—few consumers of men’s health media would realise, for example, that the average general practitioner will see only one new case every 20 years.

    Surely it’s time for sense and science to put the brakes on the men’s health bandwagon? Routine testicular self examination is an activity that is illogical and potentially harmful, and is based not on evidence but on something that, many years ago, simply seemed like a good idea at the time.

    In fact, such evidence as there is suggests that a key issue is not so much men failing to notice swellings but men failing to act on them, with one study recording, in over a quarter of patients, a delay of at least three months before presentation. This might be a useful message to convey to men, if there’s one to convey at all. But at present it’s drowned out by the noise from campaigns that succeed only in turning the nation’s blokes into ball watching neurotics.

    http://www.bmj.com/content/344/bmj.e2120

    Source: HealthNewsReview
    Gregory D. Pawelski

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    Distinguished Community Member Ging's Avatar
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    So what is the answer, can or does prostate cancer lead to testicular cancer? I did not see what the thought is on this in the elderly ? My husband had very aggressive prostate cancer about six years ago and had 49 radiation treatments. they could not remove it or do the seed implants because he had already had colon cancer and the closeness of the surgery made it a bad choice.
    Great post by the way ! Ging

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    Distinguished Community Member gpawelski's Avatar
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    Ging

    Yes. Testicular cancer is most common in men between the ages of 20 and 45. However, the "exact" cause of most cases of testicular cancer is not known, leaving open the thought about prostate cancer. But it can almost always be treated successfully (in younger men).

    According to the American Cancer Society, during the past few years, researchers have learned a lot about certain changes in chromosomes and DNA that may cause normal testicular germ cells to develop into germ cell tumors. Chromosomes are long strands of DNA and protein that carry genetic information about inherited traits. Each sperm or egg cell has half as many chromosomes as other body cells. So when the sperm and egg combine, the resulting embryo has a normal number of chromosomes, half of which are from each parent. This is why we tend to look like our parents.

    Meiosis is the process by which germ cells with 46 chromosomes develop into sperm or egg cells with 23 chromosomes. Testicular germ cell tumors may form when something abnormal happens during meiosis. Instead of forming normal sperm cells with 23 chromosomes, all 46 chromosomes remain. Usually, these chromosomes become unstable and progressively more abnormal in their shape and number (often between 69 and 82) as the cells continue to divide. Testicular cancer cells often have extra copies of a part of chromosome 12 (this is called isochromosome 12p). Scientists are studying DNA from this chromosome to learn more about exactly what goes wrong during meiosis and how this might be prevented or reversed.

    Several other abnormal chromosomes and changes in the factors that regulate cell division and the cell cycle have been associated with testicular cancer, both in animals and in humans. All of these changes are being studied to find the true causes of testicular cancer.

    Ironically, your husband had colon cancer before prostate cancer. A University of Michigan Health System study found prostate cancer "treatment" linked to high rate of colon cancer.

    http://www2.med.umich.edu/prmc/media...ls.cfm?ID=1828

    I was well aware that myelodysplastic syndrome (MDS) can be caused by treatment with chemotherapy. I was rudely reminded that radiation therapy can cause it too (treatment-related MDS or secondary MDS). Treatment-related MDS is often more severe and difficult to treat than de novo MDS (unknown changes to the bone marrow). I lost my brother-in-law (my wife's brother) to MDS after he received permanent seed implants for "early" prostate cancer treatment (he was in his '70s). I have experienced for the second time in my life, the issue: sometimes, while a life may be saved, a life may be taken, by treatment.

    So maybe its can prostate cancer "treatment" cause testicular cancer? Who knows?

    Greg
    Gregory D. Pawelski

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