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Testicular cancer with small metastatic burden: optimal approach in 2024
Kit L Yuen1, Kshitij Pandit, Dhruv Puri
1Department of Urology, University of California San Diego, La Jolla, CA, USA.
Purpose Of Review:
Recent advancements in the management of clinical stage II (CS II) testicular cancer have transformed it into a predominantly curable condition. This success in treatment advancements has markedly extended patient survival. However, these treatments carry risks and morbidities, which is important to consider given the disease's impact on young men and the emerging understanding of long-term treatment consequences.
Recent Findings:
Emerging data support primary retroperitoneal lymph node dissection (RPLND) for select CS II seminoma patients, with similar short-term outcomes to chemotherapy but less treatment intensity. Recent studies have also challenged the reflexive use of adjuvant chemotherapy for pathologic node-positive disease, as growing evidence shows low relapse rates regardless of nodal stage. Furthermore, novel biomarkers like circulating serum microRNA-371a-3p levels can help predict the presence of viable germ cell tumor at time of RPLND.
Summary:
Advances in risk stratification and therapy enable personalized de-escalation approaches for oligometastatic testicular cancer, optimizing survivorship. Upfront RPLND, reassessing adjuvant systemic therapy for RPLND pN+ disease, and novel biomarkers will shape precision treatment to achieve high cure rates with excellent quality of life. Ongoing trials of reduced-intensity regimens, accurate prognostic models, improved surgical strategy, and emerging biomarkers represent the next frontier in tailored curative therapy.
Insights
Clinical stage II testicular cancer is highly curable. Precision medicine, including upfront retroperitoneal lymph node dissection and novel biomarkers, offers tailored treatment to improve outcomes and quality of life for young men.
Area of Science:
- Oncology
- Urology
Background:
- Clinical stage II (CS II) testicular cancer management has advanced, improving survival rates.
- However, treatments carry significant risks and long-term consequences, particularly for young men.
Approach:
- Evaluating primary retroperitoneal lymph node dissection (RPLND) for select CS II seminoma patients.
- Challenging the routine use of adjuvant chemotherapy for node-positive disease based on emerging evidence.
- Investigating novel biomarkers, such as serum microRNA-371a-3p, for predicting tumor viability.
Key Points:
- Primary RPLND shows comparable short-term outcomes to chemotherapy with reduced treatment intensity.
- Low relapse rates observed in pathologic node-positive disease suggest a reassessment of adjuvant chemotherapy necessity.
- Circulating microRNA-371a-3p levels may predict viable germ cell tumor presence before RPLND.
Conclusions:
- Risk stratification and therapeutic advances enable personalized de-escalation strategies for oligometastatic testicular cancer.
- Future precision treatment will integrate upfront RPLND, reassessment of adjuvant therapy, and novel biomarkers for high cure rates and improved quality of life.
- Ongoing research focuses on reduced-intensity regimens, prognostic models, surgical strategies, and biomarkers for tailored curative therapy.
