Prostate and testicular cancer

KEY POINTS ABOUT TESTICULAR CANCER

Worldwide, testicular cancer is a relatively rare cancer, accounting for 1% to 2% of all cancers (>52,000 new cases and almost 10,000 deaths worldwide every year); however, it is the most common cancer among men 15 to 40 years of age.
Major risk factors for testicular cancer include congenital anomaly (cryptorchidism), as well as prior unilateral testicular cancer, HIV infection, and family history of testicular cancer.
With treatment, 5-year survival rates exceed 95% for all stages. Stage I is often managed with surgery alone, whereas more advanced stages often include a combination of surgery (orchiectomy) and systemic cisplatin-based chemotherapy. Retroperitoneal lymphadenectomy and/or radiation therapy may also be offered to patients with nodal involvement.
Treatment-related cardiovascular toxicities are associated in particular with the use cisplatin-based chemotherapy and radiation therapy.

Cardiovascular (CV) disease and cancer have consistently been the top two contributors to the burden of chronic disease and the leading causes of death in the United States. Cancer treatments including chemotherapy, androgen-deprivation therapy and radiotherapy are associated with an increased risk of CV events. The incidence of cardiotoxicity varies by the type and duration of treatment received, and preexisting CV risk factors at baseline.

This chapter provides a short overview of prostate and testicular cancer, their treatment and treatment-related CV toxicities.

Testicular cancer

Incidence

Testicular cancer is the most common cancer among men 15 to 40 years of age in the United States and Europe, and incidence has increased over the past several decades.

Risk factors

The etiology of germ-cell testicular cancer remains largely unknown. Several epidemiology studies support the association determined in utero , such as congenital anomaly (cryptorchidism), as well as prior unilateral testicular cancer, HIV infection, and a family history of testicular cancer.

Diagnosis and staging

Testicular tumors usually present as a nodule or painless swelling of one testicle, which may be noted incidentally by the patient or his sexual partner. In some cases, a man with prior atrophic testis will note a unilateral enlargement and may complain of a dull ache or heavy sensation in the lower abdomen or perianal or scrotal area.

Testicular cancer is staged using clinical and radiographic information that has treatment and prognosis implications. Staging is based on the primary tumor (T), lymph nodes (N), and distant metastases (M) (TNM) staging system developed by the American Joint Committee on Cancer and the Union for International Cancer Control, which applies to both seminomas and non-seminomatous germ cell tumors.

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