The UroOnc Minute: Biomarkers in Testicular Cancer, with Christian D. Fankhauser, MD, MPH

Welcome back to The UroOnc Minute!

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, speaks with Christian D. Fankhauser, MD, MPH, leader of the Urology Clinic Kantonsspital Winterthur in Zürich, Switzerland. The discussion focuses on the evolving role of biomarkers in testicular cancer, a disease that is highly curable but still poses important challenges related to treatment toxicity and long-term survivorship. As Fankhauser explains, although cure rates approach 97% even in metastatic disease, many patients are young men in their 20s and 30s who may face significant long-term complications from chemotherapy. This reality has intensified efforts to refine risk stratification and explore opportunities for treatment de-escalation without compromising oncologic outcomes.

Fankhauser outlines the limitations of currently used serum tumor markers, including alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH). While these markers can support diagnosis and surveillance, their sensitivity and specificity remain imperfect. A negative marker result does not reliably exclude disease, and mild elevations during follow-up can create uncertainty, often necessitating continued reliance on imaging. As a result, clinicians may face difficult decisions that risk either overtreatment or undertreatment in a population already vulnerable to the long-term effects of therapy.

Looking ahead, the conversation highlights 2 promising biomarker approaches that may reshape testicular cancer monitoring: circulating tumor DNA (ctDNA) and microRNA-based assays. Early studies suggest ctDNA may achieve diagnostic accuracy around 90%, although questions remain regarding cost, assay standardization, and validation across larger cohorts. According to Fankhauser, microRNA testing has generated considerable excitement in recent years. He describes how early research, beginning with seminal work published in JCO, demonstrated strong diagnostic performance and dynamic declines during chemotherapy.¹ More recent investigations suggest microRNA assays may outperform traditional serum markers in diagnostic accuracy, though imaging remains essential in surveillance strategies.

As Weiner and Fankhauser discuss, the next critical step will be determining whether these biomarkers can meaningfully alter clinical practice, potentially reducing the need for frequent imaging or enabling earlier detection of recurrence. Ongoing research and prospective trials will help clarify their role in surveillance protocols and risk stratification. For practicing urologists, the field represents a rapidly advancing area of testicular cancer care, with the potential to improve monitoring while minimizing treatment-related burden for patients.

REFERENCE

1. Dieckmann KP, Radtke A, Geczi L, et al. Serum Levels of MicroRNA-371a-3p (M371 Test) as a New Biomarker of Testicular Germ Cell Tumors: Results of a Prospective Multicentric Study. J Clin Oncol. 2019 Jun 1;37(16):1412-1423. doi:10.1200/JCO.18.01480