Why does metastatic testicular cancer have a high cure rate?

[mhco]

Hi,

I have read that primary testicular cancer has amongst the best cure rates for any cancer which is understandable. However apparently the prognosis for metastatic disease is also very good too (http://www.ncbi.nlm.nih.gov/pubmed/16620142?dopt=Abstract).

I am interested to know why the prognosis for metastatic testicular cancer is good, as compared to other cancers, which usually have poor prognoses once metastasised.

Any educated guesses or explanations would be much appreciated.

Thanks in advance.

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[pd1112]

Hi,

I have read that primary testicular cancer has amongst the best cure rates for any cancer which is understandable. However apparently the prognosis for metastatic disease is also very good too (http://www.ncbi.nlm.nih.gov/pubmed/16620142?dopt=Abstract).

I am interested to know why the prognosis for metastatic testicular cancer is good, as compared to other cancers, which usually have poor prognoses once metastasised.

Any educated guesses or explanations would be much appreciated.

Thanks in advance.

Typically easily resectable primary tumor and highly sensitive to chemotherapy. Most other metastatic cancers don't have both of those characteristics.

 

[rigid]

Any educated guesses

Really?

 

[mpdoc2]

Hi,

I have read that primary testicular cancer has amongst the best cure rates for any cancer which is understandable. However apparently the prognosis for metastatic disease is also very good too (http://www.ncbi.nlm.nih.gov/pubmed/16620142?dopt=Abstract).

I am interested to know why the prognosis for metastatic testicular cancer is good, as compared to other cancers, which usually have poor prognoses once metastasised.

Any educated guesses or explanations would be much appreciated.

Thanks in advance.

The reason that most testicular cancers are curable is that most are Germinomas which are highly sensitive to Radiotherapy and Chemotherapy. A stage I Germinoma should be observed after an inguinal orchiectomy but about 30% of them recur and are easily salvaged with radiotherapy or chemotherapy. Staage IIA/B are also usually curable with upfront adjuvant treatment.

 

[cpants]

The reason that most testicular cancers are curable is that most are Germinomas which are highly sensitive to Radiotherapy and Chemotherapy. A stage I testicular cancer should be observed after an inguinal orchiectomy but about 30% of them recur and are easily salvaged with radiotherapy or chemotherapy. Staage IIA/B are also usually curable with upfront adjuvant treatment.

Um, I wouldn't say that a stage one testis cancer should be observed. That may be an option but it depends on the path and markers. Adjuvant chemo, RPLND, and radiation may also be the best option for stage I cancers.

 

[mpdoc2]

Um, I wouldn't say that a stage one testis cancer should be observed. That may be an option but it depends on the path and markers. Adjuvant chemo, RPLND, and radiation may also be the best option for stage I cancers.

That's absolutely incorrect. Stage I Germinoma patients should be observed after surgery. You really should learn more about oncology before commenting on Oncologic cases. Read the current guidelines on NCCN before subjecting your patients to unnecessary treatment.

 

[napoleondynamite]

Um, I wouldn't say that a stage one testis cancer should be observed. That may be an option but it depends on the path and markers. Adjuvant chemo, RPLND, and radiation may also be the best option for stage I cancers.

RPLND?! Really? For stage I you would even consider that????

 

[cpants]

That's absolutely incorrect. Stage I Germinoma patients should be observed after surgery. You really should learn more about oncology before commenting on Oncologic cases. Read the current guidelines on NCCN before subjecting your patients to unnecessary treatment.

That is not "absolutely incorrect". I think you sir are the one who needs to read the NCCN guidelines. Treatment for stage I testis cancer is dependent on the pathology and stage. For stage I seminoma, options after orchiectomy are surveillance, primary chemo, or RT. For stage I nonseminoma/mixed GCT, options after orchiectomy include surveillance, primary chemo, or RPLND. Like I said, it depends on the path and stage.

You made a generalized statement that stage I testis cancers should be observed, which is not what current guidelines say.

RPLND?! Really? For stage I you would even consider that????

For stage IB nonseminoma, yes. It is an option which should be discussed with the patient.

 

[mpdoc2]

That is not "absolutely incorrect". I think you sir are the one who needs to read the NCCN guidelines. Treatment for stage I testis cancer is dependent on the pathology and stage. For stage I seminoma, options after orchiectomy are surveillance, primary chemo, or RT. For stage I nonseminoma/mixed GCT, options after orchiectomy include surveillance, primary chemo, or RPLND. Like I said, it depends on the path and stage.

You made a generalized statement that stage I testis cancers should be observed, which is not what current guidelines say.



For stage IB nonseminoma, yes. It is an option which should be discussed with the patient.

You should really learn what it means for something to be a Category I recommendation by NCCN (ie what you should do) and other categories of recommendations (ie what you shouldn't do). Also, I was specifically talking about Germinomas (which are the far majority of Testicular cancers and what the OP was referring to when he asked about the good survival of these cancers). You really should learn to read. I believe that's a problem with Urologists today. A very significant lack of knowledge of oncology due to their lack of reading and keeping up with the literature.

 

[cpants]

You should really learn what it means for something to be a Category I recommendation by NCCN (ie what you should do) and other categories of recommendations (ie what you shouldn't do). Also, I was specifically talking about Germinomas (which are the far majority of Testicular cancers and what the OP was referring to when he asked about the good survival of these cancers). You really should learn to read. I believe that's a problem with Urologists today. A very significant lack of knowledge of oncology due to their lack of reading and keeping up with the literature.

I'm not sure why you keep calling it germinoma. It's called seminoma. The OP made no reference to seminoma. He just said testicular cancer which obviously includes nonseminoma. Metastatic nonseminoma also has an excellent prognosis, although the treatment is different.

I agree that surveillance is usually the most appropriate option for stage I testis cancers. I don't agree that it is the only option, as you stated. Many patients are not great candidates for surveillance due to noncompliance or patient preference.

We get that you don't like urologists. No one cares. Go away.

 

[mpdoc2]

I'm not sure why you keep calling it germinoma. It's called seminoma. The OP made no reference to seminoma. He just said testicular cancer which obviously includes nonseminoma. Metastatic nonseminoma also has an excellent prognosis, although the treatment is different.

I agree that surveillance is usually the most appropriate option for stage I testis cancers. I don't agree that it is the only option, as you stated. Many patients are not great candidates for surveillance due to noncompliance or patient preference.

We get that you don't like urologists. No one cares. Go away.

A germinoma of the testes is a Seminoma (again some reading is helpful). The OP was clearly speaking of germinomas and so was I, if you can read that is. I have no hate for urologist, just against dumb people killing/over treating others.

 

[cpants]

I know what a germinoma is. That is not the nomenclature used when discussing testis cancer. The OP was not talking about germinomas in specific. You are the only person talking about germinomas. The language he used was "testicular cancer" which is a much broader entity. The review article he linked to is also about testicular cancer in general, not seminoma in specific.

You obviously misunderstand what the categories of recommendation in the NCCN guidelines mean. It's not category 1 is what you should do and other categories are what you should not do. Most surgical treatments do not have level 1 evidence as it is nearly impossible to run randomized controlled trials of surgery. Hence, most surgical treatments are 2a.

I've already agreed that surveillance is preferred for stage I seminoma, and I never said it wasn't. However, there are other NCCN-recommended treatments (ie. chemo or radation) that are more appropriate for some patients. For stage IB NSGCT, RPLND or chemo are actually the preferred options over surveillance.