To characterize postchemotherapy (PC) orchiectomy pathology and identify clinical factors associated with residual viable disease in patients with testicular germ cell tumors (TGCT) who undergo deferred orchiectomy after upfront chemotherapy for high-volume or site-critical metastases.
We retrospectively reviewed patients with metastatic TGCT who underwent PC orchiectomy at Princess Margaret Cancer Centre between 1992 and 2025. Clinical, ultrasound, and pathologic features were compared between patients with benign vs. viable testicular pathology. Relapse-free survival (RFS) and cancer-specific survival (CSS) were estimated using Kaplan-Meier methods, and logistic regression was used to identify predictors of residual viable disease.
Eighty-two patients underwent PC orchiectomy, with a median follow-up of 3.7 years. Teratoma was present in 36 patients (44%), germ cell neoplasia in situ in 4 patients (4.9%), and seminoma in 2 patients (2.4%). At five years, RFS and CSS were 92.2% and 94.5% for patients with benign pathology, compared to 64.9% and 81.6% for those with viable disease (teratoma and/or invasive germ cell tumor [iGCT]) (P < 0.001 and P = 0.089, respectively). Predictors of viable disease included younger age, palpable testicular mass, poor-risk IGCCCG classification, receipt of second-line chemotherapy, and adverse PC ultrasound features (vascularity and/or coarse calcifications). No viable iGCT was found in patients with PC ultrasound demonstrating normal, "burnt-out" findings, or residual testicular masses < 1 cm.
In selected patients, residual viable iGCT following chemotherapy was uncommon, although nonbenign pathology remained frequent. While some patients demonstrated favorable postchemotherapy testicular pathology, reliable tools to distinguish benign pathology, teratoma, and viable iGCT remain limited. Accordingly, testis-preserving strategies should be considered cautiously within carefully selected clinical contexts, and their safety and effectiveness require further evaluation through prospective or multi-institutional studies.
Urologic oncology. 2026 Apr 02 [Epub ahead of print]
Ahmad Mousa, James Hayes, Ali Amiri, Lynn Anson-Cartwright, Eshetu G Atenafu, Philippe Bedard, Di Maria Jiang, Rachel Glicksman, Peter Chung, Padraig Warde, Martin O'Malley, Susan Prendeville, Robert J Hamilton
Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada; Department of Surgery, Division of Urology, Princess Margaret Cancer Centre, University of Toronto, ON, Canada. Electronic address: ., Department of Surgery, Division of Urology, Princess Margaret Cancer Centre, University of Toronto, ON, Canada., Department of Biostatistics, University Health Network, University of Toronto, ON, Canada., Department of Medicine, Division of Medical Oncology, University of Toronto, Toronto, ON, Canada., Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada., Department of Medical Imaging, University of Toronto, Toronto, ON, Canada., Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada., Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada; Department of Surgery, Division of Urology, Princess Margaret Cancer Centre, University of Toronto, ON, Canada.