Testicular cancer - position statement

This position statement presents information about testicular cancer detection and treatment. It will be updated as significant new literature is published or if there are important changes in the policy environment.

This position statement was developed and reviewed by the Public Health Committee in February 2013. It was externally reviewed by A/Prof David Smith, Research Fellow, Cancer Council NSW and A/Prof Dragan Ilic, School of Public Health and Preventive Medicine, Monash University.

Around 850 men are diagnosed with testicular cancer in Australia each year. More that half of new diagnoses are in men under the age of 35. The outlook for men treated for the disease is very good.

Recommendations

Cancer Council Australia recommends that:

• Men become familiar with the usual shape, size and feeling of their testicles, and to see their doctor if they notice a lump, swelling on the surface of the testicles, heaviness, aching or other changes.
• Medical practitioners inform men at increased risk of testicular cancer of their potential increased risk, along with potential benefits and harms associated with screening.
• Men with testicular cancer talk to their oncologist about sperm banking before commencing chemotherapy or radiation.

Population based screening for testicular cancer is not recommended (and randomised controlled trials are not warranted) given the rareness of the disease, lack of test accuracy, and favourable treatment outcomes (even when diagnosed at a late stage).

Overview

The testicles are two egg-shaped glands found in men. They produce semen and sex hormones.

Testicular cancer is one of the more rare forms of cancer with an estimated incidence of approximately 6.5 in every 100,000 men^[1]. In 2010 there were 706 new cases of testicular cancer in Australia^[1].

Young men are more commonly affected by testicular cancer, with the average age of diagnosis being around 35 years of age^[2]. There are two different types of testicular cancer: non-seminoma, a cancer of the mature germ cells affecting mostly men 15-39 years of age; and seminoma, cancer formed from immature germ cells, generally affecting men 25-49 years of age^[3].

The prognosis for men diagnosed with testicular cancer has improved dramatically since the 1970s when chemotherapy was introduced to treat the disease. Five-year relative survival for men diagnosed with testicular cancer is approximately 98%^[4].

Testicular cancer represents less than 0.1% of all cancer deaths in Australian men^[1]. In 2011, there were 16 testicular cancer deaths in Australia^[1].

Screening for testicular cancer

Testicular cancer commonly presents as a small hard lump, swelling, or change in the consistency of the testicle, or there may be a dull ache in the testicle or lower abdomen. In the majority of cases only one testicle is affected.

Self-screening

Cancer Council recommends that men become familiar with the usual shape, size and feeling of their testicles, and to see their doctor if they notice a lump, swelling on the surface of the testicles, heaviness, aching or other changes. A number of conditions other than cancer may cause changes in the testicles.

The only established risk factors for testicular cancer are a family history (in father or brother) of the disease, personal history of undescended testicle and previous testicular cancer^[5]. Males with these risk factors should be informed by their physicians of their potential increased risk of testicular cancer, along with potential benefits and harms associated with screening.

Population screening

There have been no randomised controlled trials on screening for testicular cancer^[6].

The U.S. Preventive Services Task Force and a 2011 Cochrane review of evidence advise that population-based screening is not beneficial (and randomised controlled trials are not warranted) given the rareness of the disease, lack of test accuracy, and favourable treatment outcomes (even when diagnosed at a late stage)^[6][7].

Treatment for testicular cancer

All testicular cancers can be effectively treated if diagnosed and treated early^[8]. Cancer of the testis is the most curable of all internal cancers^[4]. Advanced testicular cancer can also be cured with treatment^[9][10].

In most men with testicular cancer treatment involves the surgical removal of the affected testicle. This may be followed with surveillance, chemotherapy or radiotherapy.

Testicular cancer and the removal of one testicle does not alter sexual function or fertility. The effect on fertility of removal of one of the testicles is minimal as such large numbers of sperm are produced by a single testicle.

For those men who require further treatment, fertility is likely to be affected, at least temporarily^[11]. Cancer Council recommends that men with testicular cancer talk to their oncologist about sperm banking before commencing chemotherapy or radiation.

'Late' side effects can occur years after treatment for testicular cancer. Secondary cancers and cardiovascular disease are the most common serious late effects of treatment for testicular cancer, typically occurring more than 10 years after treatment for the disease^[11]. In patients treated for Stage I testicular cancer, the lifetime increased risk for a secondary cancer is estimated to range from 1.9% for an 18 year old patient to 1.2% for a 40 year old patient^[12].

Public health information

Due to the lack of evidence of a benefit from screening for testicular cancer^[6] and the low mortality rates of the disease^[1], a public education campaign is unlikely to reduce the mortality rate further.

The low mortality rate suggests that men are currently seeking medical attention when they notice an abnormality in their testicles and are being treated effectively, resulting in the high survival rate for this disease.

A public campaign encouraging men to become more aware of abnormalities in their testicles would likely lead to an increase in unnecessary medical examinations and investigations, with no evidence there would be a significant increase in disease outcomes to justify this.

Further to this, encouraging testicular self-examination has the potential to create unnecessary anxiety and fear, with no evidence of benefit.