Age at Diagnosis Important in Testicular Cancer

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No one wants to be diagnosed with cancer at any age, but in the case of testicular cancer (TC) it is better to be diagnosed younger than 40 years of age. Risk of death doubles for those diagnosed after age 40.

Lois B. Travis, MD, ScD, Rubin Center for Cancer Survivorship, James P. Wilmot Cancer Center, University of Rochester Medical, and colleagues have published their study findings online ahead of print in the Journal of Clinical Oncology.

The researchers used data from the Surveillance, Epidemiology and End Results program (1978 – 2006), a source for U.S. cancer statistics at the U.S. National Cancer Institute, to calcute the 10-years TC-specific mortality among 27,948 patients.

Independent predictors used were age at diagnosis, social economic status (SES), race, marital status, extent of disease (EOD), calendar year of diagnosis, radiotherapy, and retroperitoneal lymph node dissection (RPLND).

TC-specific mortality was found to be doubled among US patients diagnosed with seminoma (HR 2.00) or nonseminoma (HR 2.09) after age 40, even when initial treatment and EOD are taken into account. TC-specific mortality was more than 6 to 8 times higher in metastatic disease diagnosed over age 40 (HR, 8.62 for seminomas; HR, 6.35 for nonseminomas)

Seminomas are responsible for 50% of all testicular cancer cases. They are generally slow-growing and very responsive to treatment.

Nonseminomas tend to grow and spread faster than seminomas. Tumor types include embryonal carcinoma (about 20% of all testicular cancers); yolk sac carcinoma (most common in infants and young boys); choriocarcinoma, a rare and extremely aggressive cancer; and teratomas.

Unmarried men had two-to three-fold excess mortality compared to married men (HR, 2.97, seminomas; HR, 1.54, nonseminomas).

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Decreased SES and nonwhite race were found to be negative factors among nonseminoma patients.

Diagnosis after 1987 resulted in reduced mortality compared to earlier calendar years (HR, 0.58, seminomas; HR, 0.74, nonseminomas).

Not having a retroperitoneal lymph node dissection (RPLND) was associated with seven-fold increase in death (P

The researcher wrote, "The question, however, remains whether association between socioeconomic variables and mortality reflect differences in the health care system's ability to offer optimal treatment, the patient's willingness to accept intensive treatment with a non-negligible risk of adverse effects, or the physician's knowledge of optimal treatment approaches."

The researchers recommended giving more attention to the care of older patients as well as those of people of lower SES for the best results.

Symptoms of testicular cancer vary and may include any of the following:

  1. Small, hard lump that is often painless
  2. Change in consistency of the testicles
  3. Feeling of heaviness in the scrotum
  4. Dull ache in the lower abdomen or the groin
  5. Sudden collection of fluid in the scrotum
  6. Pain or discomfort in a testicle or in the scrotum

Many of these symptoms are not cancer, but if you notice one or more of them for more than two weeks, see your doctor.

SOURCE:
Adverse Prognostic Factors for Testicular Cancer–Specific Survival: A Population-Based Study of 27,948 Patients; Fossa SD, Cvancarova M, Chen L, Allan AL, Oldenburg J, Peterson DR, and Travis LB; Published online before print February 7, 2011, doi: 10.1200/JCO.2010.32.3204 JCO February 7, 2011 JCO.2010.32.3204

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