Testicular Cancer Ups Rates of Risky Prostate Cancer Later On

Pam Harrison

February 24, 2015

Men with a history of testicular cancer not only have a greater risk of developing prostate cancer, the disease is more likely to be of intermediate to high risk when it does develop, a registry analysis shows.

The study was presented during a press conference ahead of the Genitourinary Cancers Symposium (GUCS) 2015, in Orlando, Florida.

"Further validation studies are needed to confirm these findings based on other cohorts to determine if men with testicular cancer should have closer [than usual] screening for prostate cancer," Mohummad Minhaj SIddiqui, MD, University of Maryland School of Medicine, Baltimore, told the press conference.

"But based on these findings, we believe that men with a history of testicular cancer should consider a discussion regarding the risks and benefits of prostate cancer screening with their physician," he added.

Previous studies have demonstrated that men with a history of testicular cancer have an upwards of two- to threefold greater risk for prostate cancer over time.

However, it was not known whether there is an important subset of men with a history of testicular cancer who are at risk for intermediate- to high-risk prostate cancer.

Investigators used the Surveillance, Epidemiology and End Results (SEER) registries to compare men who had a history of testicular cancer to a control population of men who had a history of melanoma. The group with a history of melanoma acted as a control, because there is no known association between melanoma and prostate cancer, the investigators noted.

Only men older than 60 years were included in the analysis to allow sufficient time for prostate cancer to develop.

A total of 32,435 men with a history of testicular cancer of all subtypes were included in the analysis.

Prostate cancer incidence and grade were compared between those with a history of testicular cancer and 147,044 men with a history of melanoma.

By the age of 80, the cumulative incidence of prostate cancer was significantly higher, at 12.6%, among men with a history of testicular cancer, compared with 2.8% of the control participants.

Similarly, the cumulative incidence of intermediate- or high-risk prostate cancer was 5.8% among men with a history of testicular cancer, compared with 1.1% for melanoma control patients.

Whether the prostate cancer was of intermediate or high risk was determined on the basis of a Gleason score of 7 or higher.

The findings suggest that testicular cancer was associated with a 4.7 times' greater risk of developing all prostate cancer (hazard ratio [HR]: 4.7; P <.0001) and a 5.2 times' greater risk of developing intermediate- or high-risk disease (HR: 5.5; P < .0001), investigators add.

"We looked at alternative risk factors, such as age, race, and radiation therapy, and even when controlled for the influence of these risk factors, there was still an increased risk of developing intermediate- to high-risk prostate cancer in men with a history of testicular cancer compared with controls," Dr Siddiqui said.

"It is too soon to make any practice recommendations based on this single study, but findings provide groundwork for further research into the biologic link between the two diseases," he added.

However, Dr Siddiqui reminded reporters that the chances of developing intermediate- to high-risk prostate cancer are low and that 95% of men with a history of testicular cancer will not get it.

Commenting on the study, Charles Ryan, MD, ASCO expert and professor of clinical medicine and urology, University of California, San Francisco, told the press conference that it is important to point out that this study really relates to the fact that men with a history of testicular cancer have a greater risk of developing intermediate- and high-risk prostate cancer, not just all prostate cancer.

He also felt it was important to correct for the influence of radiation therapy in interpreting the data, which the study investigators did.

No source of funding for the study was disclosed. The authors have disclosed no relevant financial relationships. Dr Ryan reports receiving honoraria from Astellas and Janssen, acting as a consultant for Bayer and Millenium, and receiving research funding from BIND, Karyopharm, and Novartis.

Genitourinary Cancers Symposium (GUCS) 2015. Abstract 177. To be presented February 26, 2015.

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