STOCKHOLM, SWEDEN (UroToday.com) - Testis cancer is the most common cancer in men aged 15-40 years, and the incidence is increasing.
Known risk factors include cryptorchidism, family history, infertility, and Klinefelter’s syndrome. While most patients present with a palpable testis mass and an absence of other symptoms or findings, some present with retroperitoneal mass, gynecomastia, and elevated serum tumor markers. The presence of CIS/ITGCNU (intratubular germ cell neoplasia) represents a precursor lesion for germ cell tumors. ITGCNU develops along with other disorders of the male reproductive organs during early fetal development, due to hormonal disturbances. Prenatal testicular dysgenesis syndrome can lead to postnatal reduced semen quality, CIS and testis cancer, hypospadias, and testis maldescent.
Early detection of ITGCNU conveys a possible method of predicting and preventing invasive testis cancer, but a number of diagnostic dilemmas exist. CIS cannot be detected by ultrasound or semen analysis. Testis biopsy is the only accepted diagnostic tool but is invasive, has a 2.5% rate of complications, is associated with a false negative rate of 0.5%, and pain following biopsy is often underreported. Recommendations regarding testis biopsy vary geographically; in Denmark, everyone with a testis tumor is offered a contralateral testis biopsy, while the EAU guidelines recommend consideration of contralateral testis biopsy. To justify the risks and costs of biopsy, there must be a considerable chance of finding pathology, and there must be a benefit to treating the pathology. In high-risk patients such as those with history of cryptorchidism, 2-3% have CIS on biopsy, but biopsy is recommend only if orchiopexy was performed late. Treatment of CIS may prevent cancer development, but treatment side effects can include infertility and testosterone deficiency. Orchiectomy should be considered in patients with a healthy contralateral testis, and radiotherapy for those with solitary testis or bilateral CIS. In patients with testicular microlithiasis, microcalcifications found on ultrasound in 3% of men, there is no increased risk of cancer in the absence of other factors, and recommendations for biopsy vary widely. In conclusion, CIS predicts cancer development, but testis biopsy is needed for diagnosis. Side effects to CIS treatment must be considered prior to treatment, especially in young men.
Presented by M. Fode at the 29th Annual European Association of Urology (EAU) Congress - April 11 - 15, 2014 - Stockholmsmässan - Stockholm, Sweden.
Written by Jeffrey J. Tomaszewski, MD, medical writer for UroToday.com