Testicular intraepithelial
neoplasia (
TIN; also called
carcinoma in situ of the testis) is the uniform precursor of testicular
germ cell tumors. There is general agreement on the
biological significance of
TIN, however, the treatment is still a matter of dispute. The present review summarizes the treatment options currently available. In general, the management of
TIN has to be adapted to the particular clinical situation of the patient. Eradication of
TIN usually implies the loss of fertility. Therefore, fertility aspects should be considered before any kind of treatment is employed. Usually, patients with
TIN have only small residual potential of fertility. Nonetheless, individual patients may qualify for sperm banking or cryopreservation of testicular tissue for future sperm extraction (TESE) and assisted fertilization. The most common clinical situation is the case of contralateral
TIN in the presence of unilateral
testicular cancer. Low dose
radiotherapy to the testis with 18 Gy is the standard management option in these patients. The same procedure may be applied to solitary testicles after partial
orchiectomy for
germ cell tumors. During follow-up,
testosterone levels should be evaluated every six months. If
chemotherapy is required due to metastatic disease of the primary
tumor management of
TIN should be deferred. After
chemotherapy 30% of
TIN cases will persist and approximately 42% will recur in the later course. Repeat biopsy should be done six months after completion of
chemotherapy or later. Only in cases with persistent
TIN additional
radiotherapy should be administered. If one testicle is afflicted with
TIN while the other testis is in healthy condition (conceivable in
infertility cases or patients with primary extragonadal
germ cell tumors), then the
TIN-bearing testis should be excised.
Radiotherapy is not feasible in these cases because of shielding problems with the healthy testis.