Before I discuss the causes of testicular cancer I will briefly review the statistics regarding this cancer.
In the US about 6,000 new cases of testicular cancer are diagnosed every year.
This cancer accounts for about 350 deaths in the US per year. The wide discrepancy between these two figures reconfirms that this cancer gets diagnosed early and is treated very successfully. Similar to cervical cancer, it is a “good news” story. In American white men the rate is about 4 per 100,000 men, while the American black men’s rate of testicular cancer is 1 per 100,000 men.
The reason for this is not known, but it might be due to genetic differences. The lifetime probability for an American white man to get testicular cancer is 0.2%. The peak occurrence of testicular cancer is between the ages of 20 to 40. There is a smaller late peak in men older than 60 years of age.
It is known since the mid 1850’s that the condition cryptorchism, where the testicle did not descend fully through the inguinal canal, is related to subsequent testicular cancer formation. Cryptorchism leads to a 10-fold higher risk factor for testicular cancer. It is not known why in a particular patient testicular cancer develops.
However, we have learnt a lot about germ cell tumors (see below) and this has shed light also on testicular cancer. It is now widely accepted that germ cells that stayed behind in embryological life in a different location than in the descended testicle would be the equivalent of a pre-malignant condition. It is a curious fact that even those patients with cryptorchism whose testicles were surgically moved down into the normal location, are at an increased risk for testicular cancer later in life. Similarly, although only 2% of testicular cancers occur on both sides, about 50% of those that do are in patients with cryptorchism. However, when testicles in abnormal locations (cryptorchism, thanks to www.surgeryencyclopedia.com for this image) are removed (this procedure is called “orchiopexy”) before puberty, the risk for testicular cancer disappears. This fact becomes even more important when extragonadal germ line tumors are studied.
Another important cause of testicular cancer (and of prostate cancer) is aging and the associated hormone deficiency (Ref. 7). Testosterone is continuously being secreted less from about 30 to 35 years onward (Ref. 8), which leads to weight gain. Estradiol is normally only 1/20 the level of testosterone or less in a younger man (Ref. 7). In an older man estrogen is being preserved or even elevated from the previous level by aromatase, an enzyme found in fatty tissue, which converts whatever little testosterone is left into estrogen (Ref. 9). The ratio of estrogen to testosterone should be 1:20 or more, but in the aging man it is often less, which is another important cause of cancer in general, and of testicular cancer in particular. Exercise, weight loss and bio-identical testosterone as cream are the remedy against this.
1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter on Cancer of the Testis.
2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on Cancer of the Testis.
3. Votrin II et al. Drugs Exp Clin Res 2000;26(5-6):267-273.
4. B Aschhoff Drugs Exp Clin Res 2000;26(5-6):249-252.
5. Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc
7. John R. Lee: “Hormone Balance for Men – What your Doctor May Not Tell You About Prostate Health and Natural Hormone Supplementation”, © 2003 by Hormones Etc.
8. Abraham Morgentaler, MD “Testosterone for Life – Recharge your vitality, sex drive, muscle mass and overall health”, McGraw-Hill, 2008
9. http://www.dcnutrition.com/miscellaneous/detail.cfm?RecordNumber=475 (Winston W. Greene, B.A.,B.S., D.C.: “MALE HORMONES – General Discussion”)