Testicular cancer articles within Nature Reviews Urology

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  • News & Views |

    The current serum tumour markers α-fetoprotein, human chorionic gonadotrophin, and lactate dehydrogenase show limited value for testicular cancer relapse detection. A recent study highlights that false-positive elevations in follow-up monitoring are common and, conversely, many patients do not have elevations despite proven relapse. These findings highlight the potential for circulating microRNAs to be used as improved biomarkers for relapse detection.

    • Matthew J. Murray
    • , Cinzia G. Scarpini
    •  & Nicholas Coleman

  • Review Article |

    This Review summarizes current knowledge regarding salvage high-dose chemotherapy in relapsed germ cell tumours. The authors outline data from phase I and II clinical trials, phase III randomized trials and retrospective datasets, discuss controversies and provide recommendations.

    • Michal Chovanec
    • , Nabil Adra
    •  & Lawrence Einhorn

  • Review Article |

    Stage I testicular germ cell tumour is restricted to the testicle and can be mostly cured by orchiectomy; however, many patients experience tumour relapse. In this Review, the authors describe advantages and limitations of the currently available predictive biomarkers of relapse in germ cell tumours, and discuss the need to identify new biomarkers to avoid patient overtreatment.

    • Peter Lesko
    • , Michal Chovanec
    •  & Michal Mego

  • Review Article |

    Currently, ~95% of patients with testicular germ cell tumour are cured. Although cured, these men face potential late adverse effects and reduced quality of life. This Review outlines these adverse effects with recommendations on how to minimize their severity.

    • Michal Chovanec
    • , Jakob Lauritsen
    •  & Gedske Daugaard

  • Review Article |

    In this Review, van de Merbel et al. provide a comprehensive overview of the current patient-derived tumour models in use for urological cancers and discuss their advantages and limitations, as well as their potential for personalized treatment.

    • Arjanneke F. van de Merbel
    • , Geertje van der Horst
    •  & Gabri van der Pluijm

  • Review Article |

    Here, the authors discuss embryonic microRNAs that are highly expressed in testicular germ cell tumours, critically assess the clinical utility of monitoring these microRNAs in the circulation and compare their diagnostic performance with the classic serum tumour markers.

    • Kristian Almstrup
    • , João Lobo
    •  & Klaus-Peter Dieckmann

  • Comment |

    Current clinical issues in testicular germ cell tumour management include limited sensitivity and specificity of conventional biomarkers and, therefore, reliance on serial CT imaging in follow-up monitoring, as well as poor ability to risk stratify patients. Circulating microRNAs are likely to help overcome these challenges and, importantly, could offer cost savings to health-care systems.

    • Matthew J. Murray
    •  & Nicholas Coleman

  • News & Views |

    A polygenic risk score (PRS) analysis reported that familial testicular germ cell tumours (TGCTs) were significantly enriched for TGCT risk alleles and that ≥84% were attributable to polygenic enrichment, supporting the polygenic aetiological basis of familial TGCT. Clinical application will first require improved TGCT screening and early detection tools.

    • Mark H. Greene
    •  & Ruth M. Pfeiffer

  • News & Views |

    Platinum-based chemotherapy continues to be linked with the subsequent development of various solid tumours. In a large analytical study of >5,800 survivors of testicular cancer, Groot and colleagues observed statistically significant dose-dependent increases in gastrointestinal cancer incidence after platinum-based chemotherapy, providing evidence for a potential dose-dependent relationship.

    • Chunkit Fung
    •  & Lois B. Travis

  • Year in Review |

    Our biological understanding of TGCTs has been improved using sequencing, and molecular profiles associated with the genomic evolution and development of cisplatin resistance have been identified. The genomics of variants underpinning TGCT predisposition is being delineated. Studies of circulating microRNAs have demonstrated their potential for noninvasive diagnosis and disease monitoring.

    • Matthew J. Murray
    •  & Clare Turnbull

  • Review Article |

    A need for improved serum diagnostic tests for testicular germ cell tumours (GCTs) exists owing to the unsatisfactory performance of currently used markers. In this Review, Murray and colleagues discuss the current serum diagnostic tests for testicular GCTs, including α-fetoprotein, human chorionic gonadotrophin and lactate dehydrogenase, and the future use of novel universal biomarkers such as microRNAs.

    • Matthew J. Murray
    • , Robert A. Huddart
    •  & Nicholas Coleman

  • Review Article |

    Care must be taken to limit the long-term risks of treatment of stage I testicular germ cell tumours (TGCT) as long-term survival is ∼99%. The management of this disease remains controversial as the options are to overtreat to prevent relapse, or to observe and treat only patients who experience disease relapse. In this Review, Chovanec and colleagues discuss the options for the management of clinical stage I TGCT.

    • Michal Chovanec
    • , Nasser Hanna
    •  & Costantine Albany

  • Review Article |

    The genomic landscape of testicular germ cell tumour (TGCT) risk is dominated by inherited genetic factors, which are highly polygenic in nature. Here, the authors discuss results from genome-wide association studies that have identified risk loci associated with TGCT risk.KIT–KITLGsignalling is currently the major pathway that is implicated in TGCT formation.

    • Kevin Litchfield
    • , Max Levy
    •  & Clare Turnbull

  • News & Views |

    Despite its excellent prognosis, optimal management of stage I seminoma remains controversial, with variations in expert opinion and international guidelines, particularly in terms of uncertainty regarding long-term treatment complications. Recent population-based reports shed new light on the subject, and help clarify the important, unresolved clinical questions that require further research to answer.

    • Guy C. Toner

  • News & Views |

    Data are lacking on the role of histological risk factors (such as embryonal carcinoma and lymphovascular invasion) for occult metastasis in adolescents with testicular germ cell tumours. Investigators of a pilot study have now retrospectively reviewed a testis cancer database to identify risk stratification criteria in this population.

    • Leendert H. J. Looijenga

  • Year in Review |

    The pursuit of reduced-intensity treatments for testicular cancer continued with vigour in 2013. For those with metastatic disease and poor prognoses, an alternative to bleomycin, etoposide and cisplatin chemotherapy emerged. These advances suggest we are making progress by reducing treatment intensity with personalized approaches for this highly curable malignancy.

    • Jan Oldenburg
    •  & Sophie D. Fosså

  • Review Article |

    Any mass discovered in the testicle might be cancerous and, therefore, every effort must be made to characterize the lesion. This Review highlights modern aspects of clinical examination, the modalities for scrotal imaging, and the surgical techniques used for exploring the testis.

    • Klaus-Peter Dieckmann
    • , Ulrich Frey
    •  & Guntram Lock

  • News & Views |

    Testicular germ cell tumours are the most common malignancy in young adult males. Recent data suggest that the predominant histological subtype appears to be shifting towards seminomas, which is mirrored in an increasing age at presentation. However, as nonseminomatous tumours present earlier, recent declines in its incidence might be more informative of overall trends.

    • Mausam Singhera
    •  & Robert Huddart

  • News & Views |

    New data suggest that microRNAs of the miR-371∼373 and miR-302 clusters are promising biomarkers for serum-based detection of malignant germ cell tumours (MGCTs). PCR quantification of these noncoding RNAs can improve the accuracy of MGCT diagnosis, providing greater sensitivity and specificity than traditional markers such as α-fetoprotein and human chorionic gonadotrophin.

    • Matthew J. Murray
    •  & Nicholas Coleman

  • News & Views |

    A recent survey of radiation oncologists has evaluated barriers to surveillance rather than adjuvant therapy for postorchiectomy management of stage I seminoma. The findings suggest that providers are underestimating the late toxicity of radiation therapy in these patients.

    • Nicklas Pfanzelter
    •  & Justin E. Bekelman

  • Review Article |

    Although the incidence of testicular cancer has been increasing over the past several decades in many developed countries, the causes are poorly understood. The prevailing hypothesis that an individual's level of risk is likely determinedin utero, or early in childhood, is undermined but much evidence that exposure to various factors in adolescence and adulthood is also linked to the development of testicular cancer. In this Review, the authors discuss these adolescent and adult risk factors for testicular cancer, including those occupational and environmental in nature.

    • Katherine A. McGlynn
    •  & Britton Trabert

  • News & Views |

    In the last 3 years, three major trials involving patients with advanced germ cell testicular tumors have investigated dose-intense alternatives to standard BEP (bleomycin, etoposide, and cisplatin) therapy. All three trials failed to reach their accrual targets and none was able to demonstrate improved results.

    • Michael V. Williams
    •  & Danish Mazhar

  • News & Views |

    Cancer survivors often report difficulties with memory and concentration—sometimes referred to by patients as “chemobrain” or “chemofog”. The results from two recent studies suggest that, while chemotherapy itself may not be associated with cognitive impairment, some patients might already be experiencing cognitive difficulties before treatment is even started.

    • Robert Zachariae
    •  & Mimi Yung Mehlsen

  • Review Article |

    Testicular cancer is one of the most curable neoplasms and mainly affects young men, meaning that complications arising from its treatment can have long-term effects. In this Review, the authors discuss the various types of adverse effects associated with chemotherapy treatment of testicular cancer, considering the etiologies of these conditions, and possible strategies for their prevention and management.

    • Chunkit Fung
    •  & David J. Vaughn

  • Review Article |

    Serum tumor markers play a more critical role in testicular germ cell tumor management than in any other solid organ malignancy. Here, Barlow and colleagues discuss how the serum levels of AFP, hCG and LDH provide essential information for the differential diagnosis, staging, risk-stratification and surveillance of testicular tumors.

    • LaMont J. Barlow
    • , Gina M. Badalato
    •  & James M. McKiernan

  • Review Article |

    In this Review, Zuniga and colleagues discuss partial orchiectomy as a viable alternative to radical surgery for selected patients with testicular lesions. Although currently only suitable for men with bilateral germ cell tumors or a solitary testicle, organ-sparing techniques might soon be considered appropriate for men with a normal contralateral testis.

    • Alvaro Zuniga
    • , Nathan Lawrentschuk
    •  & Michael A. S. Jewett

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