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Infertile Men Face Higher Testicular Cancer Risk, Doctors Warn

A new study from Cornell Medical Center and New York-Presbyterian Hospital is warning men diagnosed with infertility about their potentially increased risk of developing testicular cancer.1

Cancer Caveat
Marc Goldstein, MD, and his colleagues wrote that men with both an infertility diagnosis and abnormal sperm count face 20 times the risk of developing cancer of the testicle compared to men in the general population. Goldstein is Surgeon-in-Chief of Male Reproductive Medicine and Surgery at New York-Presbyterian and Weill Cornell Medical Center, and the study's head researcher.

"Patients and physicians should be aware that one cause of male infertility is cancer, particularly testicular cancer," Goldstein stated. "Screening for testicular cancer could now become a standard part of all male infertility treatment."

Comparing Risks
The study, published in the November issue of the Journal of Urology, involved medical chart evaluation of nearly 4,000 men who had been treated for infertility during a 10-year period. Of this group, ten men (0.3 percent) had been diagnosed with testicular tumors. Two of those with cancer had a history of cryptorchidism (kript-or-kid-IHZ-ihm), the condition in which one or both testicles fail to descend into the scrotum. The remaining eight men had no identifiable risk factors for testicular cancer.

Goldstein then compared the risk of testicular cancer in this group with a group of 100,000 men matched in composition by both race and age in the general population. In this group, the incidence of cancer was about 10.5 men per 100,000 during the same time period. Based on the incidence of cancer in the infertile group versus the men from the general population, Goldstein and his team concluded that the risk of contracting cancer of the testicle in men who were infertile was nearly 23 times that of fertile men. Even when the men with a history of cryptorchidism were excluded, the risk was still more than 18-fold, the researchers reported.

According to a press release about the study, the likelihood of finding a testicular tumor is one in 500 infertile men screened compared, for example, to one cancer patient of 1,438 women screened for breast cancer using a mammogram.

Highly Treatable and Curable
Finding testicular cancer at an early stage is not uncommon. In some cases, early cancers of this type may cause symptoms that prompt men to seek medical attention. A lump on the testicle is often the first sign. But there are some testicular cancers that do not cause symptoms until after reaching a later stage.

Most physicians have concurred that examining a man's testicles to look for signs of cancer should be included in a general physical exam.2 Once this form of cancer is found, it can be highly treatable.

The large majority of testicular cancers develop in germ cells, which produce sperm. The main types of germ cell tumors that occur in men are known as seminomas and nonseminomas, with the latter occurring in 40% of cases and the former making up the rest.

Other tumors also develop in the supportive and hormone-producing tissues, or stroma, of the testicles. These are known as gonadal stromal tumors, but account for less than 4% of all testicular cancers.3

Further Tests Advised
Based on his findings, Goldstein says even in cases in which men have enough sperm to undergo assisted reproductive techniques (ART), they should seriously consider consulting a urologist for an examination and ultrasound of the testicles. "Examination of all infertile men by a urologist is justified," he stressed.

However, why the two might be linked isn't yet known. Some experts contend that it may be related to a cellular abnormality in the testes that erupts before birth or soon afterwards.4 But this has not yet been proven.
 
1. Raman JD, Nobert CF, Goldstein M. Increased incidence of testicular cancer in men presenting with infertility and abnormal semen analysis. J Urol 2005 Nov;174(5):1819-22;discussion 1822.
2. American Cancer Society. Can Testicular Cancer be Found Early? Available at:
http://www.cancer.org/docroot/cri/content/
cri_2_4_3x_can_testicular_cancer_be_found_early_41.asp?. Accessed December 7, 2005.
3. American Cancer Society. What is Testicular Cancer? Available at:
http://www.cancer.org/docroot/cri/content/
cri_2_4_1x_what_is_testicular_cancer_41.asp? Accessed December 7, 2005.
4. de Kretser D. Testicular cancer and infertility. BMJ 2000 Sept 30;321(7264):781-2.


John Martin is a long-time health journalist and an editor for CuraScript. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.



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