Treatment options for carcinoma in situ testis

Abstract

Carcinoma in situ testis (CIS) is known as the precursor of germ cell cancer of the testis. International guidelines on diagnosis and treatment are inconsistent. Some countries offer routine biopsies of the contralateral testicle in relation to orchidectomy for testicular cancer, whereas other countries only offer this to high-risk patients. The treatment options range from orchidectomy and chemotherapy to radiotherapy and in rare cases surveillance. Results of the different treatment strategies are presented in this review. The optimal radiation dose is still not clarified. Most patients have been treated in the dose range of 16-20 Gy. Higher doses involve a higher risk of androgen insufficiency. Radiotherapy is recommended in patients with contralateral CIS. Orchidectomy should be offered in extragonadal germ cell cancer and CIS in one testicle, whereas patients with bilateral CIS should be offered radiation therapy. Patients who have undergone chemotherapy for testicular cancer are still at risk of developing CIS and we also recommend radiotherapy to the affected testicle in these patients. Cryopreservation should be offered before treatment is initiated and all patients should have their androgen status measured on a regular basis to find those cases where hormone substitution is needed.

Treatment of testicular intraepithelial neoplasia (intratubular germ cell neoplasia unspecified) with local radiotherapy or with platinum-based chemotherapy: A survey of the German Testicular Cancer Study Group

“…Technical problems may have accounted for this failure because the very small atrophic testicle of this patient probably caused targeting problems. The high cure rate of 97.5% reported here accords with the experience in more than 300 irradiated patients documented to date [13,16,25,26,28,30,31].…”

“…Further, the high cure rate needs to be balanced against a 30% rate of hypogonadism [13,16,41]. Evidently, this functional loss secondary to radiotherapy is dose dependent [41,15], and it develops despite grossly unchanged morphology of Leydig cells [24,16].…”

“…Treatment options encompass orchiectomy, local radiotherapy of the testis or surveillance according to European Consensus guidelines [11,12]. The rationale of radiotherapy is, first, to eradicate TIN cells and second, to preserve the Leydig cells for hormone production ( Figure 1) as well as to preserve the external shape of the scrotum for the preservation of the masculine body image [13]. Irradiation with [16][17][18][19][20] Gy is effective in almost all of the cases [14].…”

The role of apparent diffusion coefficient values in detecting testicular intraepithelial neoplasia: Preliminary results

“…TIN is found in testicular tissue adjacent to TGCNs in about 90% of cases, and it is observed in all clinical groups known to be at high risk for testicular cancer, including contralateral testis of patients with TGCN, cryptorchidism, infertility and ambiguous genitalia. If TIN is left untreated, there is a 50% probability of progressing to frank TGCN within 5 years and a 70% probability of developing malignancy within 7 years [3][4][5]7,8].…”

“…Testicular germ cell neoplasms (TGCNs) constitute 90-95% of testicular tumors [1]. Testicular intraepithelial neoplasia (TIN) or intratubular germ cell neoplasia of unclassified type (ITGCNU) is considered the precursor of most TGCNs [2][3][4][5][6][7]. TIN is found in testicular tissue adjacent to TGCNs in about 90% of cases, and it is observed in all clinical groups known to be at high risk for testicular cancer, including contralateral testis of patients with TGCN, cryptorchidism, infertility and ambiguous genitalia.…”