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Testicular cancer is one of the most common solid organ cancer of young men. Early diagnosis and treatment can cure most patients, with 5-year survival rates of approximately 95%.

It is well known that there is an increased risk of developing contralateral testicular germ cell tumor (TGCT) in men with a prior history of testicular germ cell tumor -- the incidence is 12 to 18 times higher than in the general population. Within the group of survivors of testicular cancer the risk is higher for men diagnosed before age 30.

Norwegian researchers had their experience with patients who had testicular cancer and observed that chemotherapy can reduce the risk of contralateral TGCT to 1.7% from 3.2% with surgery alone.

have now studied a similar group of patients in the Netherlands who were diagnosed between 1989 and 2007. They evaluated a cohort of 4,755 patients with testicular cancer who were treated for testicular cancer before the age of 50. A total of 136 patients among this group had a contralateral TGCT and their clinical characteristics were compared in a case-control design with a matching subcohort of 783 patients.

The study observations were similar to those of the Norwegian experience published in 2021. Key findings were as follows:

• The median interval from the time of primary diagnosis to metachronous CTGCT was 6.1 years, suggesting that the first 5 years are crucial in physical examination and monitoring to diagnose these early recurrences or new primaries and to treat them with curative intent. The risk stayed high up to 20 years and thus emphasizes the importance of self-exam on an ongoing basis

• The incidence was higher in patients who had seminomatous germ cell tumors as compared with non-seminomatous tumors

• The risk of developing contralateral testicular germ cell tumor is much lower in patients who received chemotherapy as compared with surgery alone -- 1.7% vs 4.4%, respectively. There was incremental benefit with each additional cycle of chemotherapy in reducing the risk of contralateral TGCT

A possible hypothesis is that chemotherapy penetrates the blood-testis barrier and eliminates any malignant or premalignant cells. However, it is unclear why that benefit is observed in long-term follow-up of over 20 years.

Even though these findings were observed in the geographically limited group of patients, they are consistent with other similar observation studies and provides guidance to the physicians taking care of patients with testicular cancer in recommending regular testicular self-exam to detect new cancers in the contralateral testis.

Parminder Singh, MD, is assistant professor of hematology/oncology at the Mayo Clinic in Scottsdale, Arizona.

Read the study here and an interview about it here.