Can Novel Biomarkers Augment Traditional Surveillance Paradigms in Early-stage Testicular Germ Cell Tumors? A Case Study in Pre-clinical Relapse Detection Using a Combination Micro-RNA-371a-3p and 372-3p Assay.

OBJECTIVE

To report the case of a patient with clinical stage IA pure seminoma, managed with surveillance, who participated in a prospective study of serial miRNA (miR-371a-3p and miR-372-3p) testing as a means of highlighting the potential role that novel serum biomarkers may have in the management of patients with early-stage testicular cancer.

METHODS

We report the patient's clinical course, relevant diagnostic studies, treatment, and outcomes focusing on how miRNA levels indicated a relapse prior to traditional imaging and serum tumor markers. We also provide a roadmap for potential implementation of miRNA testing as part of surveillance for early-stage testicular cancer.

RESULTS

This is a case of a 43-year-old male with CSIA seminoma who was treated initially with an orchiectomy and then managed with surveillance according to established clinical guidelines. Conventional STMs remained non-elevated and serial cross-sectional imaging was negative through 18 months of surveillance. At 21 months, miRNA testing (miR-371a-3p and miR-372-3p) converted to positive; shortly thereafter, routine computed tomography scan at the 24-month mark of surveillance revealed a new 4.3 × 3.7 cm right common iliac nodal mass consistent with metastatic seminoma. The patient was subsequently treated with chemotherapy and had a complete response.

CONCLUSION

This case illustrates that miRNA-informed surveillance may detect relapse in early-stage testis cancer prior to traditional diagnostics. Incorporating miRNA assays into surveillance algorithms could lead to risk-adjusted and non-invasive monitoring thus reducing dependence on repeated axial imaging. Prospective, standardized protocols and assay harmonization are needed prior to routine clinical integration in the early-stage setting.