Histologic Concordance Between Post-chemotherapy RPLND and Orchiectomy When Performed Simultaneously: Insights Into the Blood-Testis Barrier.

Objective: To compare the histology of patients undergoing concomitant orchiectomy and PC-RPLND to understand the interaction of chemotherapeutics with the blood-testis barrier.

Methods: We identified patients undergoing orchiectomy at the time of PC-RPLND using an institutional database. Concordance between the PC-RPLND and orchiectomy histology was assessed. Univariable logistic regression for age, mass size, pre-chemotherapy RP biopsy, and testis mass size, and receipt of bleomycin chemotherapy on detecting teratoma in the orchiectomy specimen was performed.

Results: Fifty-seven patients undergoing orchiectomy at the time of PC-RPLND were identified. Concordance between PC-RPLND and orchiectomy pathology was observed in 29 (50.9%) patients. Univariable analysis demonstrated that pre-operative RP mass size (OR 0.93, 95% CI 0.80-1.07), receipt of bleomycin (OR 1.56, 95% CI 0.42-5.8), pre-chemotherapy testis mass size (OR 1.11, 95% CI 0.83-1.47), age at surgery (OR 0.99, 95% CI 0.70-1.39), pre-chemotherapy RP histology (OR 2.4, 95% CI 0.48-11.8), nor time from chemotherapy to surgery (OR 1.0, 95% CI 0.72-1.39) were associated with finding teratoma on orchiectomy.

Conclusion: With 60% of testis masses revealing necrosis, chemotherapy appears to penetrate the blood-testis barrier, however, with a 1.5% incidence of ITGCN, its ability to do so is not predictable. Since identifying teratoma in the testis remains a challenge, delayed orchiectomy in patients undergoing upfront chemotherapy should remain a standard of care.