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Research

Find out about the latest UK research into testicular cancer.

All cancer treatments have to be fully researched before they can be used for everyone. This is so we can be sure that:

  • they work
  • they work better than the treatments already available 
  • they are known to be safe

The latest research into causes, prevention and treatment for testicular cancer is outlined below.

Cancers develop because genes are damaged inside body cells. In testicular cancer, the gene damage is thought to happen at a young age, even when inside the womb.

Over the last century there has been:

  • a steady increase in testicular cancer
  • an increase in cases of undescended testicle – a known risk factor for testicular cancer
  • a fall in sperm counts

These trends may be due to a common factor: high levels of oestrogen (a female hormone) in mothers during pregnancy, for example.

A number of lifestyle and environment factors probably increase the risk of testicular cancer. Researchers continue to investigate what these factors might be.

Chromosome 12

Researchers have found that almost all testicular tumours have an abnormality on chromosome 12. They are looking into using this knowledge to help diagnose testicular tumours. It may also help them to predict whether a testicular tumour is likely to respond well to chemotherapy.

Chromosomes 5, 6, 9 and 12

A study of the genetic causes of testicular cancer found 8 genetic changes (variants) that increase testicular cancer risk. These changes lie on chromosomes 5, 6, 9 and 12. The researchers hope the results from this study will help them to understand how testicular cancer develops. They are also involved with the UK genetics of testicular cancer study to help them find out more.

TGCT1

Up to 1 in 5 men may have an increased risk of testicular cancer because of a faulty gene that they've inherited. This gene is called TGCT1 (testicular germ cell tumour 1). If a man inherits a faulty version of this gene, his risk of getting testicular cancer may increase by up to 50 times. This gene fault may also be linked with a family history of undescended testicle, or with men who develop cancer in both testicles. 

The Leeds Testicular Cancer Study is trying to find out more about the causes of testicular cancer, as well as identifying genes that may be important in the development of this disease.

In the 1970s, a breakthrough drug called cisplatin was developed that dramatically improved the outlook for men with advanced testicular cancer.

Today, more than 95 out of every 100 men (95%) diagnosed with testicular tumours are cured. Current research centres on:

  • improving the quality of life for testicular cancer patients, both during and after treatment
  • cutting down on the amount of treatment given to cure testicular cancer that has a good outlook
  • finding better ways of identifying and treating the small proportion of patients whose cancer will not respond to standard treatment
  • improving follow up so that the cancer is picked up very early if it does come back

Researchers are looking at ways of reducing the side effects of chemotherapy for testicular cancer.

BEP chemotherapy

The combination of drugs usually used to treat non seminomas of stages 2 to 3 is bleomycin, etoposide and cisplatin. This is known as BEP chemotherapy.

A trial called TE3 compared giving bleomycin continuously over 3 days to the standard way of giving it – separately each day. The aim was to see if this reduced the side effects to the lung. The researchers found that a slow continuous infusion of bleomycin was no better than the standard way. When the researchers compared the results of breathing tests (lung function tests) between the 2 groups after chemotherapy, they found no differences.

A small trial looked at giving 2 weekly BEP chemotherapy instead of the usual 3 weekly cycles. 16 patients took part in the trial. The trial team found that it was possible to give BEP every 2 weeks and so should this should now be looked at in a larger randomised trial.

The 111 trial is looking at giving a single cycle of BEP chemotherapy (bleomycin, etoposide and cisplatin) for testicular cancer. Doctors usually give 2 cycles of BEP. The aim of this trial is to find out if a single cycle of BEP at a higher dose is as good as 2 cycles of BEP at the standard dose. This trial has now closed and we are waiting for the results. 

CBOP BEP chemotherapy

The TE 23 trial was a phase 2 trial which looked at a combination of chemotherapy drugs called CBOP BEP for men with a poor prognosis germ cell cancer. This combination adds carboplatin and vincristine to the drugs used in BEP chemotherapy.

The trial team found that CPOP BEP may be better than BEP for this group of men. But larger studies are needed to find out how well CPOP BEP works to prevent cancer coming back.

New drugs

Researchers are investigating new drugs such as paclitaxel (Taxol) to see if they lower the chance of the cancer coming back even further.

A trial called TE21 looked at testing paclitaxel with BEP chemotherapy. The researchers found that this combination of chemotherapy was safe and may help to stop intermediate prognosis seminomas and non seminoma germ cell tumours from coming back.

Seminomas are particularly sensitive to radiotherapy. Most early stage seminomas are treated successfully with a combination of surgery and radiotherapy.

Seminomas are also sensitive to chemotherapy. Researchers have found that carboplatin chemotherapy works as well as radiotherapy for stage 1 seminomas. It also causes fewer side effects. So these days radiotherapy is rarely used for stage 1 seminomas. 

High dose carboplatin chemotherapy

The CarPET study is looking at replacing BEP chemotherapy with high dose carboplatin chemotherapy to treat seminoma that has spread to the lungs.

The researchers want to see if giving carboplatin at a higher dose than usual works as well as the BEP combination of chemotherapy, but with fewer side effects.

The study is also looking at having a PET-CT scan before and after your first cycle of treatment, to see if it helps doctors assess any early response to treatment more accurately. The researchers want to see if this works better than a standard CT scan.

This study has now closed and we are waiting for the results.

There is a study looking at how useful CT scans are in the long term follow up of men with non seminoma testicular cancer.

Most men who have treatment for testicular cancer are cured, but the cancer can come back in a small number of men. So doctors in this trial are using CT scans as well as the usual blood tests and physical examination. They will see if they can pick up a recurrence of the cancer earlier than in men who do not have scans.

CT scans and MRI scans

CT scans expose you to some radiation. This may increase the risk of developing another cancer.

The TRISST trial is looking into the best way to follow up men with stage 1 seminoma testicular cancer, after they have surgery. This trial is comparing CT scans with MRI scans, which do not use radiation. The trial is also looking at how often these scans need to be done, to pick up any signs of the cancer coming back.

This trial has now closed and we are waiting for the results.

Sometimes standard treatment isn’t successful or there’s a high risk that testicular cancer may come back again. In these cases doctors may want to try different approaches that may include high dose chemotherapy.

High dose chemotherapy

High doses of chemotherapy drugs can destroy testicular cancer cells. But they also cause serious harm to the healthy cells in the bone marrow, from which blood cells are made. 

These cells are called blood stem cells. Doctors can now use a treatment called peripheral blood stem cell transplant. You have blood stem cells removed from the bloodstream before having high dose chemotherapy. The stem cells are then given back through a drip after chemotherapy.

This type of treatment is still experimental. We need to know more about which combinations and doses of drugs to use, and which patients might respond best to this treatment.

TIP chemotherapy

The TIP trial looked at looked at a different combination of chemotherapy drugs for testicular cancer that came back after treatment. TIP stands for the drugs paclitaxel (Taxol), ifosfamide and cisplatin. The researchers in this trial found that TIP is a useful treatment combination for men with testicular cancer that has come back after earlier chemotherapy.

Short course chemotherapy

The GAMEC S trial is looking at giving a shorter course of chemotherapy for male germ cell tumours that have come back after treatment. The researchers want to know if giving chemotherapy for 6 weeks works as well as having it for 10 weeks. This could mean having less time in hospital and possibly less severe side effects. This trial has now closed and we are waiting for the results.

GAMMA

The GAMMA trial is looking at a different combination of chemotherapy drugs for germ cell tumours that come back after treatment. The researchers want to know whether combining the drugs actinomycin D, methotrexate, paclitaxel and oxaliplatin, helps people in this situation.

Researchers are looking into using counselling or other psychological support to help people cope with a cancer diagnosis. This type of research can make a real difference to people diagnosed with cancer.

Care for young adults

The Brightlight study is looking at the care given to teenagers and young adults with cancer. The researchers want to see if where they have treatment and what sort of healthcare professionals are involved in their care affects how well they do.

Follow up appointments

It is very important that men who have been treated for testicular cancer are regularly monitored to make sure the cancer has not come back. 

If you don't go to your follow up appointments and your cancer comes back, it may not be picked up as early as it could be. This can allow the cancer to grow – and a cancer that’s grown larger is more difficult to treat.

Studies are underway to investigate why some men miss their appointments. This will allow doctors to adapt treatment and follow up to suit individual patients.

Studying testicular cancer may help to improve the treatment of other cancers.

Testicular cancers respond very well to chemotherapy. If we know why this is, we may be able to make other types of cancer just as sensitive to chemotherapy.

Scientists have already found that this good response is partly because testicular cancer cells are very bad at repairing damage caused by chemotherapy.

A protein called XPA, which normally helps mend damage to DNA, is only found in very small amounts in testicular tumours. It is possible that scientists could design drugs to block XPA in tumours that do not respond so well to treatment.

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