Determining the Utility of ctDNA in Testicular Cancer

Research into the potential benefits of circulating tumor DNA (ctDNA) for patients with testicular cancer both before and after diagnosis is currently lacking.

A study from Reuben Ben-David, MD, and colleagues presented at the European Association of Urology Congress 2024 sought to determine the utility of ctDNA in connection with pathologic and clinical features in testicular cancer.

The single-institution study included patients who received radical orchiectomy between 2020 and 2023, as well as those who had ctDNA performed before or after surgery. Researchers reviewed patient data, including baseline characteristics, pathology results, imaging study results, and oncological treatment follow-ups from electronic medical charts.

The study comprised 41 patients with a median follow-up of 10 months. Twenty-one patients demonstrated preorchiectomy ctDNA status, and all but 2 were positive (95%). All patients with stage I disease (n=28) had negative postoperative ctDNA results. Three of the negative patients received retroperitoneal lymph node dissection (RPLND) and reported benign pathological results.

Of the stage II patients (n=6), 5 had ctDNA results, with 2 undergoing chemotherapy and converting from positive to negative. Three of the patients received primary RPLND with germ cell tumor on pathology, while 2 remained positive postoperatively and only converted to negative following continued chemotherapy. Following RPLND, 1 patient converted to negative and is under surveillance.

Only 1 patient with stage III disease had an available ctDNA result and died while undergoing chemotherapy treatment.

Dr. Ben-David and colleagues concluded that ctDNA was associated with the varying stages of testicular cancer.

“ctDNA status may be used in informing both urologists and oncologists for tailoring treatment protocols to patients with testicular cancer who have negative or mildly elevated serum tumor markers, and for treatment escalation/de-escalation,” the researchers wrote. “Further prospective studies with larger cohorts are necessary to validate these initial results.”