AUA 2020: Testicular Mass in a Prostate Cancer Survivor: Diagnosis and Management

(UroToday.com) Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35, although it accounts for only 1 percent of all cancers in men.  Ms. Dunn began her lecture by presenting a case study of a 65 yo male who was diagnosed with Gleason 3+4 adenocarcinoma of the prostate who underwent a radical prostatectomy. He subsequently was diagnosed with a hypervascular 2.6 cm right testicular mass with an additional small 0.3 cm nodule superiorly.  It was felt to be highly suspicious of a testicular neoplasm.  Orchiectomy was performed and pathology indicated diffuse large B-cell lymphoma (DLBCL). 

Primary testicular lymphoma is a rare and aggressive form of extranodal non-Hodgkin’s lymphoma (NHL).  A common histologic subtype of NHL is diffuse large B-cell lymphoma (DLBCL) which accounts for 30% of patients with NHL.  It is the most common malignant testicular tumor in men > 60 yrs. and accounts for approximately 1% of lymphomas overall. Relapses can occur in the CNS, skin, contralateral testis, and the pleura.  Recommended treatment is orchiectomy. Ms. Dunn also reviewed the use of 6 cycles of five chemotherapeutic drugs: R-CHOP — rituximab (Rituxan)-monoclonal antibody, cyclophosphamide-alkylating agent, doxorubicin hydrochloride (anthracycline), vincristine-(Oncovin, Vincasar PFS) vinca alkaloid and prednisone.  Men may also receive intrathecal or high-dose systemic methotrexate for CNS prophylaxis and scrotal radiation therapy to prevent contralateral testis recurrence.  

Presented by: Mary W. Dunn, MSN, RN, OCN®, NP‐C

Written by: Diane Newman, DNP, ANP-BC, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health

References: 

  1. Vitolo et al. First-line treatment for primary testicular diffuse large B-cell lymphoma with rituximab-CHOP, CNS prophylaxis, and contralateral testis irradiation: final results of an international phase II trial.  Clin Oncol. 2011 Jul 10;29(20):2766-72. doi: 10.1200/JCO.2010.31.4187.
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