Short- and long-term complications of therapy for testicular cancer

Restoration of the apoptosis pathways' proteins levels after orchiectomy in testicular tumour patients

Seminal plasma proteins already demonstrated to reflect the testicular environment function and important regulatory mechanisms. However, it is crucial to understand which of these proteins participate in probable altered pathways in testicular germ cell tumours and after unilateral orchiectomy. In this study, we proposed to verify, by a multiplex approach, the levels of DNA damage and apoptosis pathways' proteins, in seminal plasma of men before and after unilateral orchiectomy, and also in control men. Comparing pre- and post-orchiectomy groups, just the apoptosis pathways' proteins presented different levels, in which Bad was lower and Bcl2, Akt, caspase-9, p53 and caspase-8 were higher after orchiectomy. When comparing pre- and post-orchiectomy groups with control, both presented lower levels of ChK1, Chk2, H2AX, p53 and p21, for DNA damage pathway. Regarding the apoptosis pathway, lower levels of JNK, Bcl2, Akt, caspase-9, p53 and caspase-8 and higher levels of Bad were observed before orchiectomy. The post-orchiectomy group did not differ from controls, demonstrating a probable restoration on its proteins levels. We can conclude that testicular tumours can alter both of the assessed pathways, and its removal is associated with a probable restoration of the apoptosis pathway.

Disparities in Adolescent and Young Adult Survival After Testicular Cancer Vary by Histologic Subtype: A Population-Based Study in California 1988-2010

PURPOSE

Testicular cancer is the most common cancer among adolescent and young adult (AYA) men 15-39 years of age. This study aims to determine whether race/ethnicity and/or neighborhood socioeconomic status (SES) contribute independently to survival of AYAs with testicular cancer.

METHODS

Data on 14,249 eligible AYAs with testicular cancer diagnosed in California between 1988 and 2010 were obtained from the population-based California Cancer Registry. Multivariable Cox proportional hazards regression was used to examine overall and testicular cancer-specific survival and survival for the seminoma and nonseminoma histologic subtypes according to race/ethnicity, census-tract level neighborhood SES, and other patient and clinical characteristics.

RESULTS

Compared with White AYAs, Hispanic AYAs had worse overall and testicular cancer-specific survival (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.07-1.37) and Black AYAs had worse overall survival (HR, 1.41; 95% CI, 1.01-1.97), independent of neighborhood SES and other demographic and clinical factors. Racial/ethnic disparities in survival were more pronounced for nonseminoma than for seminoma. AYAs residing in middle and low SES neighborhoods experienced worse survival across both histologic subtypes independent of race/ethnicity and other factors, while improvements in survival over time were more pronounced for seminoma. Longer time to treatment was also associated with worse survival, particularly for AYAs with nonseminoma.

CONCLUSION

Among AYAs, race/ethnicity, and neighborhood SES are independently associated with survival after testicular cancer. Variation in disparities by histologic type according to demographic factors, year of diagnosis, and time to treatment may reflect differences in prognosis and extent of treatment for the two histologies.

Testicular cancer

OBJECTIVES

To discuss the presentation, diagnosis, chemotherapy, surgical options, nursing management, and long-term outcomes of patients with testicular cancer.

DATA SOURCES

Review and research articles, clinical experience.

CONCLUSION

Testicular cancer is very treatable and the cure rate is approximately 95%. It is most common in men between the ages of 15 and 35. While early detection, diagnosis, and treatment are all important factors for treating the disease, fertility and quality of life are also important issues to address in patients with testicular cancer.

IMPLICATION FOR NURSING PRACTICE

Nurses must provide patient instruction regarding chemotherapy, surgery, fertility, and side effects of treatment. Serving as a patient advocate regarding fertility preservation and promoting quality of life are important factors for health professionals to consider.

Shedding light on testicular cancer

Testicular cancer, though generally uncommon, is the most common cancer NPs will see in young men. Advances in surgery, radiation, and cisplatin-based chemotherapy, have made testicular cancer a "model" for a curable cancer. Survivors will likely live many years, but will require lifelong follow-up for possible recurrence and long-term treatment sequelae.

Common scrotal and testicular problems

Scrotal and testicular problems range from the benign and painless to the malignant and debilitating. The primary care physician should be able to triage these problems and know when to give reassurance and when to initiate a targeted workup that may lead to specialist intervention. This article focuses on scrotal pain and palpable abnormalities. Scrotal pain includes well-defined acute causes such as torsion and infection and the less well-defined chronic orchialgia. Palpable abnormalities covered here include cryptorchidism, hydrocele, spermatocele, varicocele, and testicular cancer.

High-risk clinical stage I NSGCT: the case for RPLND

INTRODUCTION

High-risk clinical stage I NSGCT patients are at significant risk of harbouring occult metastatic disease. In these patients, treatment options consist of retroperitoneal lymph node dissection (RPLND) or two cycles of primary BEP chemotherapy. Both these options provide a nearly 100% cure rate.

MATERIALS AND METHODS

We review the rationale for both treatments.

CONCLUSIONS

Advantages of RPLND include high cure rate with single modality therapy eliminating the need for chemotherapy with its attendant long-term toxicities in the majority of patients.

Testicular cancer patients: considerations in long-term follow-up

Over the past 30 years, testicular tumors have become the paradigm for a curable adult cancer. Numerous factors have contributed to this success, including the introduction of newer treatment approaches, such as cisplatin-based combination chemotherapy and curative retroperitoneal lymph node dissection. Moreover, the last three decades have witnessed the evolution of newer diagnostic methods, improvements in staging, the evaluation of patient response, and the monitoring of relapse. These treatment successes have been accompanied by the emergence of the late effects of testicular cancer and its treatment, including second primary cancers, cardiovascular sequelae, the metabolic syndrome, gonadal toxicity, neurotoxicity, and pulmonary sequelae. An overview of these late effects and recommendations for patient follow-up are presented in this article.