“Sometimes the best course is to do nothing,” says urologist Phillip Pierorazio, M.D., Director of the Testicular Cancer Program. “Because most men with testicular cancer are young and can expect to be cured with surgery alone, there has been an increasing push to put men on surveillance after surgical treatment of testicular cancer.”
A new Brady study, published in European Urology Focus, finds that in addition to preventing unnecessary side effects from chemotherapy and radiation, this approach might also be the most cost-effective option for men with a form of early stage testicular cancer called seminoma.
“For the vast majority of men with this type of low-risk testicular cancer, surgery alone is enough. If there is a recurrence later on, we can deal with it and the outcomes will still be excellent.”
“We created a model based on well-established data from previous studies on testicular cancer,” says Mitchell Huang, a Johns Hopkins medical student and the study’s lead author. “We simulated outcomes for men with early stage seminoma and found that over a 10-year period, active surveillance resulted in a greater quality of life at a lower cost compared to other treatment options.” In the study, the Brady team also reported that men had a very low rate of death from testicular cancer – regardless of what treatment option was selected.
“We made adjustments to the model to account for possible differences in clinical outcomes and costs,” notes Brady urology resident Tony Su, M.D. “Our findings held up across a wide range of scenarios, which gives us confidence that active surveillance after surgery should be the preferred option for men with very low-risk testicular cancer.”
The authors found very little benefit to starting men on radiotherapy or chemotherapy after surgery. “These findings really underscore what we’ve seen previously in the literature,” says Pierorazio, leader of the research team. “For the vast majority of men with this type of low-risk testicular cancer, surgery alone is enough. If there is a recurrence later on, we can deal with it and the outcomes will still be excellent.”