Unveiling testicular cancer: STM, TDS, fertility preservation, and miR-371a-3p
Four state-of-the-art lectures provided the latest insights on testis cancer and conditions during the Thematic Session “Unveiling the unseen: Management of small tumours in penile and testis cancer” led by Dr. Oscar Brouwer (NL) and Prof. Anja Lorch (CH).
In his lecture “Work-up of an indeterminate testicular mass”, Prof. Asif Muneer (GB) stated that the smaller the indeterminate/small testis mass (STM), the higher the probability that they are benign. “When you look at them, you need to understand if you want to opt for an incisional biopsy or surveillance. You can only do surveillance if the tumour markers are normal,” said Prof. Muneer. Furthermore, frozen section examination (FSE) has a < 95% accuracy, which can benefit in terms of testis-preserving surgery.
His lecture entitled “Do we fully understand testicular dysgenesis syndrome yet?”, Prof. Mikkel Mejlgaard Fode (DK) answered “no”. He explained that the Testicular Dysgenesis Syndrome (TDS) hypothesis seems likely but the evidence is circumstantial based on epidemiology and animal studies. Moreover, the key TDS components of impaired semen quality and cancer become apparent later in life and factors after birth could play a role. “The interplay among environmental, genetic, and lifestyle factors is infinitely complex and may never be fully illuminated,” stated Prof. Fode.
Dr. Philippa Sangster (GB) discussed fertility preservation options, the side effects, and success rates of some of them, and barriers in her lecture “Fertility options and considerations in testis cancer patients”. She stated “There are several fertility preservation options out there for before and during the orchidectomy, prior to the patients’ cancer treatments, or further down the line such as the future options. You shouldn’t be thinking about fertility preservation during any of these but rather when the patients receive the diagnosis of the testicular mass. Straight away, you should be considering the patient might have testicular cancer and what we should think about with regards to fertility preservation?”.
She provided information regarding the success rates and the EAU Guidelines recommendation of the onco-testicular sperm extraction (onco-TESE); the side effects of chemotherapy, radiotherapy, and retroperitoneal lymph node dissection (RPLND); as well as the barriers to fertility preservation.
According to Prof. Christian Fankhauser (CH), miR371 is ready to be used for stage 1 of testis cancer, at least. In his lecture “miR-371a-3p in active surveillance in stage I testisticular cancer: Finally ready for clinical practice?”, he said “We have to know how to deal with this new biomarker. Although it’s not accessible to everyone yet as it is costly to do so, it’s becoming more and more available in some countries. That’s why we have to show better diagnostic accuracy and treatment.”
Prof. Fankhauser added that ongoing studies are keen to demonstrate that repeated testing may improve the diagnostic accuracy of miR371 and redefine follow-up schedules. “In our protocol, the repeated testing of miR371 is mandated. Also, we should look at the other testicle, not only during systemic recurrence. Moreover, a uniform cut-off is important. Then you have the multivariable risk model such as Stockholm-3 (STHLM3), for example, which is a complicated model. You just put in the risk factors, histopathology, previous markers, the timing of the follow-up, and relative quantity (RQ) values. Then we’ll get a multivariable model and consequently, the post-test probability of health status.”