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Study: CT Scans Risky After Testicular Cancer

April 4, 2011
Written by: , Filed in: Diagnostic Imaging
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CT surveillance of early-stage testicular cancer is associated with greater risk of secondary cancers, according to a study published online last month in the journal Cancer.

John Boone, PhD, a study coauthor and a professor in the radiology department at the University of California, Davis, said:

This is the first study that I am aware of that shows that diagnostic CT scans cause cancer with statistical significance. The organizations that recommend these protocols need to reevaluate this aggressive use of CT and maybe opt for MRI or ultrasound.

Dr. Boone was quoted in a UC Davis news release.

The study looked at 7,301 men diagnosed during the period from 1988 through 2006 with early-stage nonseminomatous germ cell tumor (NSGCT), the most common type of testicular cancer. Such patients are usually offered three choices after removal of a cancerous testicle: two doses of chemotherapy, lymph node removal, or active surveillance by means of frequent CT scans.

The first two options can cause such side effects as ejaculatory dysfunction, bowel adhesions, and neuropathy. So it’s not surprising that, in the 1990s, nearly half of NSGCT patients chose active surveillance. National Comprehensive Cancer Network Guidelines recommend a total of 15 CT scans in the first five years after surgery.

The new study used statistical analysis to determine that of 10,000 patients put on active surveillance, 306 would get secondary malignancies within 15 years, compared with 233 if they had had the surgery alone. That would mean an additional 73 secondary malignancies. In comparison, only 50 of the men who underwent surgery died of testicular cancer.

Said Karim Chamie, MD, the study’s lead author:

The side effect is worse than the disease. More men are likely to get secondary malignancies than are liable to die from their active disease.

At the time of the study, Dr. Chamie was a UC Davis urology resident. He is now with the urology department at UCLA.

The risk of developing secondary cancers was greater in older men. Dr. Chamie said he suspects that younger bodies can more easily repair radiation-caused DNA damage.

Testicle-removal surgery cures 70 percent of early-stage NSGCT patients, so, for them, chemotherapy or lymph-node removal would be unnecessary overtreatment, Dr. Chamie said.

However, of those opting for active surveillance, 30 percent will develop additional cancers.

“So,” he said, “do we sacrifice the 70 percent? Or do we put 30 percent at risk of having progression and downstream effects of too many CT scans and chemotherapy? We need to do something other than active surveillance.”

Related seminar: CT/MRI of the Abdomen and Pelvis

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