Doctor and male patient discussing his care

Fewer scans needed for men with early stage testicular cancer

Men facing treatment for early stage testicular cancer could benefit from fewer monitoring scans, which expose them to potentially harmful radiation which comes from computerised tomography (CT) imaging, new research has shown.

The discovery was made as part of a Cancer Research UK-funded study, which found that using magnetic resonance imaging (MRI) instead of CT scans was just as good at picking up signs of cancer relapse.

Using fewer CT scans, or swapping these for MRI alternatives, could expose men to less harmful radiation. This is particularly important when monitoring young men, who are unlikely to die from testicular cancer and increased radiation exposure may heighten their risk of developing other cancers later on in life.

Currently, surgery is performed to remove the affected testicle in men with stage one testicular seminoma, which accounts for around 40-50% of cases, with patients then monitored to see if the cancer has come back through regular CT scans for a five-year period.

Due to this slightly increased risk for patients later in life, doctors involved in the study sought to find potential ways to reduce the amount of radiation exposure, either through alternatives to the CT scan - such as MRI scans instead, which do not use radiation - or through less frequent scanning.

Primary to the study was to ensure any alternative treatment route did not present an unacceptable increase in cases where the cancer was only detected in an advanced stage.

The TRISST clinical trial, the largest study of its kind, was led by researchers from The Institute of Cancer Research, London, Leeds and Huddersfield and UCL.

It saw 669 men with stage one testicular cancer, who had undergone surgery to remove the affected testicle, enrolled. Men were monitored either using the standard 7 CT scans, 3 CT scans or the same two regimes of frequency, but using MRI scans.

The research showed cancer returning in 12% of the men, but only a small proportion of the man - fewer than 1.5% - had advanced stage cancer at the point of detection.

The majority of these relapses happened within three years, suggesting scanning beyond this point was of less significant importance.

Professor Robert Huddart, Professor of Urological Cancer at The Institute of Cancer Research, London and Consultant in Urological Oncology at The Royal Marsden NHS Foundation Trust, who was one of the lead authors of the study, said: “When looking at a young population of men who are unlikely to die from testicular cancer, avoiding unnecessary radiation exposure is vital.

“We found that the benefit of having continued CT scans beyond 3 years was outweighed by the potentially harmful exposure to radiation, given the small number of men who relapse and our success at treating those patients.

“Our study also found that MRI could have real benefits for men with testicular cancer in achieving similar outcomes to CT but with lower doses of radiation. Reducing the number of scans men have could help alleviate the anxiety that some patients experience, as well as easing pressure on the NHS.

“We are now collecting health economic data to see if using 3 MRI scans could be recommended as the standard surveillance plan.”

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