Testicular Cancer treatment and research by Ray Sahelian, M.D.
March 12 2016

Estimated new cases and deaths from testicular cancer in the United States in 2016:
New cases: 8,720.
Deaths: 380.
Testicular cancer is a highly treatable, usually curable, cancer that most often develops in young and middle-aged men.

Testicular cancer is a rare disease, accounting for about 1% of all malignant cancers in males. Despite the low overall incidence of testicular cancer, it is the most common cancer among young men. The incidence rate has been increasing since the 1970s in many western countries. The U.S. Preventive Services Task Force and the American Cancer Society discourage the self-exams when no symptoms are present.
   Testicular cancer is known to be most common among white men, and worldwide, rates of the disease are still highest in the U.S., Canada, Australia and Europe -- particularly in Nordic countries such as Denmark and Norway. However, rates of the disease rose between 1973 and 1997 in many parts of the world -- including traditionally low-incidence countries.

Testicular Cancer Treatment
Testicular cancer is remarkable because it is curable by combination of chemotherapy even when widely disseminated. Testicular cancer treatment is defined by widely accepted staging and prognostic factors. Three cycles of bleomycin, etoposide and cisplatin has been defined as the current optimum treatment in good prognosis metastatic disease, curing 90-95% of patients. Outcomes are less impressive for patients in intermediate and poor prognostic categories. Data developed over the last few years have identified increased risks of second malignancy and cardiovascular disease in long-term survivors. This has led to re-evaluation of strategies to manage Stage I patients. In particular, the use of radiotherapy in Stage I seminoma and the need for adjuvant therapy in Stage I nonseminoma are being re-examined.

The initial work-up of testicular cancer is based on clinical, laboratory (AFP, total hCG, LDH) and imaging assessment (scrotal ultrasound and chest, abdomen and pelvis computed tomography). Inguinal orchidectomy is the first-line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. The management of stage I tumours must be adapted to the risk by explaining to the patient the benefits/disadvantages of active treatment or watchful waiting as a function of the risk of relapse. Treatment options for stage 1 seminomas comprise : watchful waiting, chemotherapy (1 cycle of carboplatin) or para-aortic radiotherapy.

Long term prognosis after testicular cancer treatment
While men with testicular cancer have a good chance of being cured, they may still not be out of danger. Though most patients with testicular cancer, even those with widespread disease, are today cured by multimodal treatment approaches, after 10 to 20 years, these cancer survivors are at increased risk to die from non-cancer causes such as infections, cardiovascular diseases and pulmonary disorders.

Fatherhood
Infertility is common in men treated for testicular cancer but a large number of them may regain their ability to father children. A study of Norwegian men treated with surgery and chemotherapy for cancer limited to one testicle found that 80 percent of those who tried, succeeded in fathering a child after therapy. European Urology, online April 2, 2010.

Long term adverse effects from chemotherapy treatment
Long-term side effects vary depending on the dose of chemotherapy given and how many cycles of chemotherapy the men received. Between 4 and 21 years after treatment for testicular cancer, Dr. Marianne Brydøy of Haukeland University Hospital in Bergen, Norway Brydøy asked 1,400 men about their symptoms of hearing loss, ringing in the ears (tinnitus), numbness or tingling in the hands or feet, and what's called Raynaud-like phenomena (discoloration of the hands or feet on exposure to cold). Compared to men who never received chemotherapy, men who had received the drug treatment reported more trouble with the aforementioned symptoms, even years after treatment. Among chemotherapy-treated men, 39 percent reported Raynaud-like phenomena, 29 percent reported hearing impairment, and 22 percent reported tinnitus as major symptoms troubling them quite a bit or very much. The men who had the most severe symptoms years later were the ones who had received high-dose treatment with cisplatin. Men in the study group who smoked regularly were more likely to have symptoms of Raynaud's, numbness or tingling in the hands or feet, and hearing impairment than the men in the study who had never smoked. Journal of the National Cancer Institute, November 25, 2009.

Testicular cancer surgery
After surgery for testicular cancer, a single dose of carboplatin appears to be just as effective in preventing relapse as three weeks of radiation therapy in men with early-stage testicular cancer. Carboplatin also appears to be associated with less severe adverse effects and lower risk of developing a tumor in the other testicle.

Cause
Potential causes include cryptorchidism (undescended testicle), high maternal body weight, and in utero exposure to estrogens. some studies have suggested that men whose mothers gave birth to them at an older age have an elevated risk of testicular cancer, possibly due to elevated levels of maternal estrogen during pregnancy. Although there are few established risk factors for testicular cancer, some appear to be related to hormonal balance at various life stages. Lifestyle and occupational exposures occurring later in life may play a role in promoting the disease, although they are not likely involved in cancer initiation. Other risk factors include white race and family history of testicular cancer.
   Pregnant women's weight is apparently associated with the subsequent risk of testicular cancer in male offspring once they become adults. Higher maternal weight leads to higher levels of estrogens, which can be transferred from mother to fetus via the placenta.

Testicular Cancer and Fertility
After treatment for testicular cancer, about 71 percent of men achieve fatherhood. However, the type of treatment has a strong impact on the paternity rate. The findings, which appear in the Journal of the National Cancer Institute, are based on a study of 554 long-term survivors of testicular cancer who attempted to become fathers following treatment.  Subjects were divided into groups based on the treatment they were given after surgery: surveillance, removal of lymph nodes, radiation, low-dose chemotherapy, and high-dose chemo. The highest paternity rate, 92 percent, was in the surveillance group, while the lowest rate, 48 percent, was in the high-dose chemotherapy group.

Symptom
An increase in the size of one of one of the testicles is often one of the signs of testicular cancer. In the early stages of testicular cancer, symptoms of pain of discomfort are not usually present.

Research
Long-term survivors of testicular cancer appear to be at increased risk of anxiety disorder. Researchers had more than 1,400 testicular cancer survivors complete a questionnaire on anxiety and depression. They found that anxiety was significantly more prevalent in the former cancer patients (19.2 percent) compared with the general population, after adjustment for age (13.5 percent).

Emails
I am 44 and an testicular cancer survivor (back when I was 33). About the time I turned 43, my libido declined like a light switch had been turned off. It went from strong to nothing in the space of about 3 months. I did research including your site and I decided to follow your recommendation of a reduced dose. I am using Walgreen supplements since they have a generally good reputation for quality but I am using a pill cutter to split them into 4 roughly 6mg pieces. I started taking them and I was astonished. The next day, my libido surged back and the response has been consistently strong and immediate when I take them. I cycle them a few days off every couple weeks so I take them about 10 days out of 14. There have been other subtle effects as well. I used to have a constant good mood that went away about the same time and I started being a bit crabby and negative. My good mood returns after a couple days of taking the supplements. I appreciate the work and research you have done on the subject and wanted to let you know it made a great positive difference in my life.

Most testicular cancer patients who try to father children after completing their treatment succeed. Men who have surgery to remove the tumor have the least problems but even patients who have radiotherapy and chemotherapy are able to have children.

Additional links
Saw palmetto herbal helper for prostate and additional beneficial
herbs that could be helpful; carnosine for free radical scavenging; creatine for bigger muscles; dopamine enhancing herb; female libido booster; galantamine for dementia; sitosterol for prostate; 5-htp and Zoloft;