Pete Postlethwaite Leaves 'Town' for Good

In the recent movie The Town, veteran British actor Pete Postlethwaite played mob boss Fergus 'Fergie' Colm disguised as a florist who, in a climactic gun battle toward the end of the film, is killed by the main protagonist Doug MacRay, played by Ben Affleck. Mr. Postlethwaite, 64, has now died for real not from the gun but rather through that Emperor of All Maladies, cancer. The type of cancer that felled the actor, whose filmography includes another recent film -- Inception -- was not reported. It is known that Mr. Postlethwaite had been successfully treated for testicular cancer in 1990, which is the most curable solid tumor with a 10-year survival rate of greater than 95%. However, men with testicular cancer continue to be at significantly elevated risk of second malignant neoplasms for more than two decades following initial diagnosis. Here we briefly review the odds of getting a second cancer after surviving testicular cancer.

According to the National Cancer Institute, “Over 10 million people in the U.S. – about one in 30 – are cancer survivors. This growing population reflects advances in cancer detection and treatment. But with the greater number of survivors comes an increasing number of people living long enough to experience more than one type of cancer in their lifetime.”

After surviving testicular cancer, the odds of getting cancer again in a lifetime are higher than someone who never had cancer. A man who has had testicular cancer has a 2-3% chance of getting testicular cancer again in the remaining testicle. However, other factors, such as type of treatment, family history and environment also increase the risk that a survivor gets a completely new and different cancer later in life.

A 2005 article in the Journal of the National Cancer Institute looked at the incidence of second cancers in a study cohort of 28,843 men with testicular cancer, including 20-year and 30-year survivors. Their findings confirmed that testicular cancer survivors had an increased rate of second cancers and that the increased risk persisted over many years. Statistically significant excesses were found for acute lymphoblastic leukemia, acute nonlymphocytic leukemia, melanoma, non-Hodgkin's lymphoma, and cancers of the stomach, colon, rectum, pancreas, prostate, kidney, bladder, thyroid, and connective tissue.

The kind of treatment received played a part in the increased risk. Higher doses of radiation during initial therapy increased the risk, although newer protocols for radiation therapy are based on lower doses and should lessen this impact. There were also statistically significant associations between chemotherapy and the risk of a second cancer. Despite the increased risk, the authors of the paper stressed that “It is clear that the remarkable gains in survival provided by treatments for testicular cancer far outweigh the risk of this serious late effect.”