From the Rikshospitalet, Cancer Clinic, National Resource Centre for Studies of Long-term Effects after Cancer; and University of Oslo, Faculty of Medicine, Division the Norwegian Radium Hospital, Oslo, Norway
Author's disclosure of potential conflicts of interest is found at the end of this article.
Address reprint requests to Sophie D. Fosså, MD, PhD, Rikshospitalet, Cancer Clinic, National Resource Centre for Studies of Long-term Effects after Cancer, Montebello, Oslo, Norway 0310; E-mail: sdf{at}radiumhospitalet.no
Overview: Because of rising incidence rates and a greater than 90% cure rate, the prevalence of survivors of testicular cancer is increasing, warranting research of the late affects facing these men. The development of a second malignancy is the most serious consequence. Compared with the general population, testicular cancer survivors have a significantly elevated relative risk of being diagnosed with a subsequent solid non-germ cell cancer. The relative risk ranges from 1.5 to 2.0 and persists for more than 35 years. For patients diagnosed with a seminoma or nonseminoma at age 35, cumulative risks of a solid cancer at age 75 were 36% and 31%, respectively, compared with 23% for the general population. Radiotherapy, chemotherapy, and the combination of both lead to increased risks of a second non-germ cell malignancy, most of them localized infradiaphragmatically with similar patterns for seminoma and nonseminoma. For nonseminoma only, the risk has decreased for patients diagnosed in 1975 or later. The published relative risks for leukemia range between three and five, mainly related to the use of chemotherapy. These relative risks decrease rapidly after the first post-treatment decade. The diagnosis of carcinoma in situ in the contralateral testicle and the subsequent development of a metachronous invasive testicular cancer are an expression of shared prenatal etiologic influences. During long-term follow-up of testicular cancer survivors, health professionals should be aware of their nearly doubled risk of being diagnosed with a new non-germ cell malignancy. In the future, risk-adapted minimal treatment may decrease this second cancer risk.
