Sperm concentration, testicular volume and age predict risk of carcinoma in situ in contralateral testis of men with testicular germ cell cancer

Abstract

Purpose: We investigated whether semen quality or some easily attainable clinical parameters might be used to estimate the risk of contralateral carcinoma in situ in patients with unilateral testicular germ cell tumors.

Materials and methods: A total of 264 Danish patients with testicular germ cell tumor with or without contralateral testicular carcinoma in situ were retrospectively investigated. Clinical data included andrological history, physical examination, testis ultrasonography, semen quality and testis histology. Study groups were compared by univariate linear regression analysis and the chi-square test. Associations between contralateral carcinoma in situ and risk factors were modeled in 2 stages: Bayes rule was used to assess the probability of carcinoma in situ; the terms in Bayes rule were estimated using regression models.

Results: Significant characteristics of patients with contralateral carcinoma in situ were lower sperm concentration, smaller contralateral testis volume, irregular ultrasonic echo pattern of the contralateral testis and younger age. Cutoff values of sperm concentration and testicular volume were defined. However, according to these only a minority of the noncarcinoma in situ cases could potentially have been spared a diagnostic testicular biopsy. Combining information on age and sperm concentration, secondly age and testis volume resulted in models of the estimated contralateral carcinoma in situ risk, from which patients at particular high risk of carcinoma in situ could be identified.

Conclusions: The combined information on sperm concentration, age and contralateral testis volume predict the risk of contralateral carcinoma in situ in patients with unilateral testicular germ cell tumor. The proposed models may facilitate selection of patients with testicular germ cell tumor for contralateral testicular biopsy at the time of orchiectomy if this is not routinely done.

Keywords: CIS; CTB; TGCT; TSC; biopsy; carcinoma in situ; contralateral testicular biopsy; semen analysis; testicular germ cell tumor; testis; total sperm count.