Photo Credit: Dr Microbe

The following is a summary of “Mini-review: Evaluation and Management of Retroperitoneal Masses in Patients with Testicular Cancer,” published in the August 2024 issue of Urology by Yang et al.

Testicular germ cell tumors (GCTs) represent the majority of testicular malignancies and are categorized into seminomas and nonseminomas, each with distinct prognoses and management approaches. The advent of cisplatin-based chemotherapy has substantially enhanced survival rates; however, the effective management of residual masses post-chemotherapy remains critical for guiding subsequent treatment and optimizing patient outcomes. In seminomas, residual masses often resolve spontaneously, making fluorodeoxyglucose positron emission tomography (FDG PET) essential for assessing these masses and guiding further intervention. Retroperitoneal lymph node dissection (RPLND) can offer therapeutic benefits for patients with seminoma, but the procedure is complicated by increased desmoplasia following chemotherapy. 

For nonseminomas, residual masses post-chemotherapy are expected, with surgical resection being necessary for masses exceeding 1 cm. The utility of FDG PET in nonseminomas is limited, thus emphasizing the importance of timely surgical intervention to achieve favorable outcomes. Teratoma, if not surgically resected, poses significant risks, including growing teratoma syndrome, malignant transformation, and late relapse. Extraretroperitoneal residual masses, particularly those containing teratoma, are associated with a poorer prognosis. Surgical resection remains the primary treatment modality, demonstrating significantly higher progression-free and recurrence-free survival rates when compared to residual fibrosis or necrosis. 

Understanding the nature of residual masses and their management following chemotherapy is crucial for refining treatment strategies and enhancing patient outcomes in testicular GCTs.

Source: sciencedirect.com/science/article/abs/pii/S2405456924000695