Practice Makes Perfect: The Rest of the Story in Testicular Cancer as a Model Curable Neoplasm

MicroRNAs as Appropriate Discriminators in Non-Specific Alpha-Fetoprotein (AFP) Elevation in Testicular Germ Cell Tumor Patients

“…The patient presented with embryonal carcinoma histology >50%-a generally histological subtype with high risk of relapse in stage I cancer (EAU guidelines 2019)-and vascular invasion in the primary tumor, both criteria warranting the administration of one cycle of PEB chemotherapy even in stage I non-seminoma germ cell tumors. In our stage IIA case, we decided to start with a curative approach with chemotherapy (PEB, cisplatin, etoposide, and bleomycine according to current treatment guidelines ( Figure 1)) [4]. The patient history revealed that the patient had been a hepatitis B surface (HBs)-antigen-carrier since childhood.…”

“…In terms of treatment and prognosis, TGCTs are subdivided into two major groups: Seminoma and non-seminomatous germ cell tumors [3]. In metastatic TGCT, prognosis and therapy depend on the location of metastases and tumor marker levels [4]. Patients are generally stratified and managed according to the International Germ Cell Cancer Consensus Group (IGCCCG) recommendations.…”

“…However, these tumor markers are increased in only about 60% of TGCT patients. Moreover, in pure seminoma patients, only β-HCG is increased in about 20% of patients [3,4]. Besides a lack of sensitivity, false positive ("non-specific") elevations of AFP in patients with non-seminomatous germ cell cancer is possible and can be caused by infectious liver disease, liver cirrhosis, or hepatocellular carcinoma [5,6].…”

Advanced Testis Cancer

“…However, testis cancer care remains complex, and given the rarity of the disease, the incremental improvement in survival for advanced disease over the past decade has been modest, with more than 400 cancer related deaths per year in the USA [1]. Instead, efforts have focused on patient-centered management, with a resultant decrease in the burden of therapy in early-stage disease [2]. Surgery remains a vital component in the management of testicular cancers and we continue to refine the indications and the extent of surgery.…”

“…After chemotherapy, at least one-third of patients with disseminated disease will have residual masses requiring surgery [4]. Although referral to expert centers has been touted for a long time by testis cancer experts, we now have evidence that experience is extremely important in optimizing outcomes [2]. A recent study using the National Cancer Data Base found that overall survival is almost 10% lower (81% vs 90%) at low-volume compared to highvolume hospitals, despite more favorable disease characteristics at the lower-volume hospitals [5].…”