Cancer Prevention – What's New in GU?

8 Things You Should Know About Testicular Cancer

In the medical world—and especially the genitourinary (GU) world – we’re pretty comfortable having candid conversations about what’s going on below the belt. After all, the “genito” half of our name refers to diseases of the genital organs. April is testicular cancer awareness month and there’s no need for the testes to be a taboo topic. Awareness is key to early detection, so here are 8 things you should know about testicular cancer:

It can develop in one or both testicles. Our bodies aren’t always exactly symmetrical and the same can be said for cancer development. Just because cancer develops in one side, it doesn’t guarantee that the other testicle will be affected.
You shouldn’t feel pain. Testicular pain isn’t normal. Visit your primary care physician and inquire about getting an ultrasound to get a better picture of what’s going on. You may also need a referral to a urologist.
Self-examinations are important. Make an effort to get in a regular habit and aim for once a month. The more you’re familiar with what’s normal for you, the easier it will be to spot something that isn’t right. Not all lumps and bumps mean cancer, but it is important to get them evaluated.
Certain men are at increased risk. While testicular cancer can affect males of all ages, most new cases occur in men between the ages of 20-34. Other risk factors include men who were born with undescended testes (when the testes don’t move into the scrotum during development), men with Klinefelter’s syndrome (two or more X chromosomes), men with a family history of testicular cancer and certain familial cancer syndromes (inherited cancer genes).
Testicular cancer has one of the highest cure rates. We have a number of successful ways to treat testicular cancer, including surgery, radiation, and chemotherapy. Seek out a specialist for evaluation if you sense something is wrong as early detection can minimize the amount of treatment needed. A typical initial work up will include an ultrasound and blood tests, and then possibly a CT scan to get a better picture of what’s going on in your body from a variety of different angles. With proper treatment nearly everyone will be cured, including those with cancer that has spread to other parts of the body.
A diagnosis doesn’t mean you can’t have kids. Most men are able to successfully father children following treatment, but there are occasional situations in which prior history, cancer, or the nature of the treatment can prevent it from happening naturally. Some centers (such as ours) are able to extract sperm, which can be utilized for fertilization. Before starting treatment, ask about your options to preserve fertility, including sperm banking.
It doesn’t signal an end to your sex life either. Following treatment, sexual function should be normal.
Some treatments should only be performed at centers of excellence. For example, in today’s treatment era, some men only need removal of the affected testicle. These men can be spared additional surgery, radiation, and/or chemotherapy that might have been administered in the past, but they remain at risk for tumor recurrence that might be missed in less experienced hands. A type of surgery called retroperitoneal lymph node dissection (RPLND) should only be performed by someone with specialized experience in this procedure. Additionally, certain types of chemotherapy regimens are very complicated and require autologous stem cell support (bone marrow transplant) to achieve cure. We happen to offer all of these specialized approaches.

A version of this article was first published on April 30, 2016.

New Research from Weill Cornell Medicine (WCM) Sheds Light on the Prevalence of Heart Attack and Stroke in Diagnosed Cancer Patients

Cancer cells produce substances that “thicken” the blood, so men and women with cancer have a significantly higher risk of developing blood clots. A manifestation of blood clots can be cardiovascular events such as heart attack and stroke. The latest research found that six months after diagnosis, people with cancer had a higher rate of heart attack or stroke.

New research from Weill Cornell Medicine (WCM), published in the Journal of the American College of Cardiology, found that patients newly diagnosed with cancer are more than twice as likely to suffer from arterial thromboembolism – a sudden interruption of blood flow to an organ or body part due to a clot that has come from another part of the body – as cancer-free patients. The types of cancers studied include breast, lung, prostate, colorectal, bladder, pancreatic and gastric cancer.

Dr. Babak B. Navi, neurologist at Weill Cornell Medicine, and his team evaluated the risk of heart attack and stroke in patients age 66 or older with new cancer diagnoses compared with people who did not have cancer. Results showed that six months after diagnosis, people with cancer had a higher rate of heart attack or stroke (4.7%) due to blood clots than people without cancer (2.2%). After the first six months, the differences in risk got smaller. One year after diagnosis, the risks were about the same in people with and without cancer. Dr. Babak Navi and his team also discovered that more advanced stages of cancer were associated with higher risk.

This research is an outgrowth of the data that Dr. Babak Navi presented at last year’s International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC) about the risk of heart attacks and stroke in women with breast cancer. Results showed that women diagnosed with breast cancer have a higher risk of a heart attack or stroke in the first year after diagnosis compared to similar women without breast cancer.

Through the latest research, we now know the risk of clotting goes beyond breast cancer and is a risk factor for many different forms of cancer. Further research is needed in order to develop optimal strategies to prevent arterial thromboembolism in patients with cancer.

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“People with cancer are known to be at increased risk of blood clots and this risk is believed to vary according to cancer type, stage of disease, and treatment modality. We also know that patients with cancer are more likely to have cardiovascular events which may be induced by tumor or its treatment,” says Dr. Scott Tagawa, medical oncologist and Director of the Weill Cornell Medicine Genitourinary (GU) Oncology Program. “This research further underscores the need to conduct clinical trials to determine the best prevention methods and treatment of thrombosis in patients with cancer.”

Mark your calendars to learn more about the cancer clotting connection at this year’s World Thrombosis Day event.

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The Cancer Conundrum: To Screen or Not to Screen?

For many cancers, the value of screening is well established. As the saying goes, “knowledge is power” and early diagnosis is usually linked with better outcomes. For prostate cancer, this topic has been more controversial. That’s because many of the tumors we discover through screening are what we call indolent tumors – prostate cancers that may never lead to symptoms or require treatment in their lifetime.

The men who are diagnosed with slow growing prostate cancers can potentially be harmed by the label, particularly if they undergo treatment and have long-term side effects as a result.

We have a number of different screening tools available to both detect the presence of prostate cancer and distinguish between the sub-types that don’t require treatment versus those that need to be treated as early as possible. One of the most common and least invasive ways to screen for prostate cancer is through Prostate Specific Antigen (PSA) testing.

PSA is a blood test that since the early 1990s has been widely used to detect prostate cancers and to follow response to treatment. This blood test is frequently incorporated as part of routine blood testing during annual physical exams for men aged 40 or older. PSA values above a “normal” threshold are associated with a greater risk of prostate cancer.

In 2012, the U.S. Preventative Health Task Force (USPSTF) recommended against routine PSA-based prostate cancer screening for healthy men, regardless of age. This recommendation was based, in large part, on results from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, a large randomized trial designed and funded by the National Cancer Institute (NCI) to determine the effect of PSA screening on prostate cancer deaths in the United States. At the time, it was determined that there was no benefit to PSA testing.

Contrary to this landmark study, a new study led by Jim Hu, MD at Weill Cornell Medicine and NewYork-Presbyterian found evidence that now demonstrates that PSA testing can help reduce the number of fatal cases of prostate cancer.

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Researchers from the Genitourinary Oncology Program at NewYork-Presbyterian and Weill Cornell Medicine will be presenting their findings at the 2016 American Urology Association (AUA) Meeting on Monday, May 9. They discussed their findings in this week’s New England Journal of Medicine in a letter to the editor questioning the results of the PLCO trial due to limitations in the study’s methodology.

According to this letter, more than 80% of the participants in the PLCO control group (who were not supposed to have PSA tested) reported having had PSA testing within three years of starting the trial or during the trial. Thus the trial was not truly studying men who had not been screened in contrast to those who had been screened.

Dr. Jonathan Shoag, urology resident and lead author on the article further explains, “We demonstrate that the PLCO study did not compare a group of men who received PSA screening to a group of men who were not screened, but compared men who were screened to other men who were screened, and we should therefore reconsider any decisions based on the study.”

While PSA testing isn’t perfect (PSA can rise due to other conditions aside from prostate cancer), it can be a very good screening tool when viewed as one piece of the larger puzzle of what’s going on in the body.

Stay tuned for additional blog updates on the topic. Next week, we’ll have continuing coverage on research from the 2016 AUA meeting, including updates on PSA as a prostate cancer screening tool, other ways to detect prostate cancer, and additional biomarkers that can be used to distinguish between aggressive and non-aggressive prostate cancers.

Together, this information allows us to see a clearer picture of what’s going on in the body in order to increase our cure rates and the number of people we’re able to treat effectively, while simultaneously minimizing interventions for those who don’t need them.