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Do Undescended Testes Predict Testicular Cancer?

To lower risk for testicular cancer, orchiopexy should be performed at a young age.

In 2007, an estimated 8000 new cases of testicular cancer will be diagnosed in the U.S. Despite the small number of patients affected, this epithelial neoplasm has particular prominence, as it is almost exclusively a disease of young men.

Treatment of this cancer was an early success story more than 2 decades ago; however, the etiology of testicular cancer remains elusive. A significant increase (2- to 8-fold) in risk for developing this neoplasm is associated with a history of cryptorchidism, but whether cryptorchidism and testicular cancer have a common cause or whether undescended testes are themselves a cause of testicular cancer is unknown. In addition, although orchiopexy typically is performed on children with persistent undescended testicles, the optimal age at which to perform the procedure remains unclear (i.e., no compelling data have been available to indicate whether earlier correction lessens risk for subsequent development of testicular cancer).

The investigators identified 16,983 men in the Swedish National Inpatient Registry who underwent orchiopexy from 1964 through 1999. The mean age at orchiopexy was 8.6 years. Patients were followed for development of testicular cancer through the Swedish Cancer Registry for a mean of 12.4 years, during which 56 cases of testicular cancer were identified. The relative risk for testicular cancer among those who underwent orchiopexy before age 13 was 2.23 (95% confidence interval, 1.58–3.06) compared with the general population; for those who underwent the procedure at age 13 or older, relative risk was 5.40 (95% CI, 3.20–8.53). When investigators examined specific age categories, young men who underwent orchiopexy at ages 13 to 15 had much higher risk than did those who were 10 to 12 at the time of their procedures.

Comment: Other groups of investigators performed small case-control studies that provided limited evidence that earlier surgical intervention decreased risk for testicular cancer. The size of the current study permitted researchers to investigate specific age strata: The data demonstrate a significantly higher risk for testicular cancer in those who were 13 at the time of orchiopexy, which provides even more compelling evidence to support the age hypothesis. The findings of this study should lead to unambiguous recommendations for early orchiopexy to decrease risk for testicular cancer.

— Robert Dreicer, MD, MS, FACP

Published in Journal Watch Oncology and Hematology May 2, 2007

Citation(s):

Pettersson A et al. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med 2007 May 3; 356:1835-41.

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