Milwaukee Journal Sentinel
NEW ORLEANS - A new study raises the intriguing possibility that testicular cancer might someday be treated the way many breast cancers are now - by removing just the cancerous lump instead of the entire organ.
Doing that might allow more men to do something the world's most famous survivor of the disease, cycling legend Lance Armstrong, has done: father children.
Nearly 9,000 cases of testicular cancer are diagnosed in the United States each year, and the vast majority are cured with surgery to remove the affected testicle and radiation to kill any cancer cells that may have spread.
But the radiation puts men at risk of developing a new cancer decades later, and surgery leaves one in 10 men infertile and one in five needing to take supplements of the male hormone testosterone.
Doctors tested a new approach to see whether it could help with both problems.
About 900 patients in Europe and the United Kingdom were given standard radiation after surgery and an additional 543 were given a single course of chemotherapy, the drug carboplatin, instead of radiation.
Three years later, survival rates were similarly high in both groups. Surprisingly, only one man in the carboplatin group developed a tumor in his remaining testicle, but seven in the radiation group did.
"We have set a new standard of care," because chemotherapy now has been shown to improve outcomes, said R. Timothy Oliver, a doctor at St. Bartholomews Hospital in London who presented results of the study last week at a meeting of 25,000 cancer experts.
Because the drug helped preserve the remaining testicle, it might also preserve more healthy tissue in the affected testicle and allow doctors to remove just the tumor rather than the whole organ, he said.
"We could make lumpectomy a standard of treatment for men as it is for breast cancer for women," he said.
Until now it hasn't been ethical to do such an experiment because the current treatment gives such a high cure rate, "but today we can justify starting this," Oliver said.
Unlike most cancers, where risk increases with age, testicular cancer strikes men typically in their 20s and 30s.
Margaret Tempero, a University of California in San Francisco doctor who is president of the American Society of Clinical Oncology, the group holding the conference where the research was presented, praised doctors for pushing for something better.
In oncology of the future, you have to look for ways to avoid things that can harm patients later or affect the quality of their lives, she said.
Robert Mayer, a physician at the Dana-Farber Cancer Institute in Boston, noted that Armstrong is one of three people on the President's Cancer Panel, which recently issued a report on cancer survivors and issues they later face.
His experiences have increased awareness of the disease and contributed to more testicular cancers being found early, when an approach such as lumpectomy could be considered.
The men in the new study need to be followed for 20 years to see what their long-term cancer risks are, but this is "the first hint that research may ultimately make it possible for testis conservation to be as routine as breast conservation," he said.
(c) 2004, Milwaukee Journal Sentinel. Distributed by Knight Ridder/Tribune News Service.