(273) COMPARATIVE RATES OF INCIDENTAL GERM CELL NEOPLASIA IN SITU IN HISPANIC MEN PRESENTING FOR INFERTILITY
Authors: Howell S , Duan M , Saffati G , La T , Desai S , Khera M 
Published: December 2024

Abstract

Introduction
The AUA Guidelines discuss germ cell neoplasia in situ (GCNIS) as a risk factor for and precursor lesion to testicular cancer. Along with GCNIS, cryptorchidism, hypospadias, and poor semen quality (infertility) comprise the Testicular Dysgenesis Syndrome associated with testicular cancer. GCNIS was initially described after incidental diagnosis during infertility evaluation. Rates of incidentally diagnosed GCNIS have been reported as 0-3.5% in various populations from 1970s-1990s; more contemporary studies found incidences between 0.54-6.3%. Hispanic men in the USA face both rapidly rising incidence of testis cancer as well as worse survival regardless of socioeconomic class or access to care. Comparative rates of incidental GCNIS in infertile Hispanic men in the United States specifically has not been reported.

Objective
In this study we reviewed cases of patients evaluated for infertility who had testicular tissue sampling to determine the rate of incidental GCNIS in comparison to non-Hispanic peers. We also reviewed the incidences of co-existing testicular dysgenesis syndrome and both history and development of testicular cancer.

Methods
All patients undergoing testicular tissue sampling for infertility evaluation or treatment were reviewed. Cases were identified by query of an existing, retrospectively maintained database and by reviewing electronic medical record data using relevant procedural codes. Testicular tissue sampling for purely oncological reasons was excluded. Included sampling types were MESA, TESA, TESE, microTESE, seminal vesical aspiration (SVA) and various percutaneous aspirations or biopsies. Each separate sampling event was reported as one case with a total of N = 157 cases reported. Cases were assigned by self-reported ethnicity to either Hispanic (n = 25) or non-Hispanic (n = 130) groups. Variables were assessed using Student’s T Test, Z test, or Pearson’s chi-square test as appropriate.

Results
Mean age at sampling in the Hispanic group versus non-Hispanic group was 31 vs 34 years (p = 0.14). Various methods for tissue sampling in both groups is shown in Table 1 (p &lt; 0.001). Rate of GCNIS was 4.0% vs 3.8% (p = 0.97). In cases with a scrotal ultrasound prior to biopsy (48% vs 42%, p = 0.60), microlithiasis was reported on 0.0% vs 1.8%. History of cryptorchidism was reported in 8.0% vs 3.8% (p = 0.36). No patient in either group had a reported history of hypospadias. Previous testicular cancer was reported in 4.0% vs 1.5% (p = 0.41). Altogether, cases with at least one additional criteria for TDS (i.e., not infertility) were 13% vs 5.3% (p = 0.18). Testis cancer was known to have developed in 4.0% vs 3.8% (p = 0.97).

Conclusions
In this study, we sought to report comparative rates of GCNIS between Hispanic and non-Hispanic men in a population at higher risk for testicular cancer. We found that Hispanic patients seeking fertility evaluation had similar rates of GCNIS, pre-biopsy scrotal imaging, microlithiasis, TDS risk factors, and testis cancer (both before and after biopsy) compared to non-Hispanic patients. Rates were similar to those found in the literature for various populations. While our study is limited by its retrospective nature and low case numbers in the Hispanic group, it represents an important starting point that should be confirmed prospectively with appropriate power.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Endo, AbbVie, Marius, Halozyme, Boston Scientific, Coloplast, Tolmar, Petros, Sprout.