First Assist: Contemporary Management of Advanced Testicular Cancer, with Katie S. Murray, DO, MS

In this episode of First Assist: GU Oncology Unpacked, host Taylor Goodstein, MD, is joined by Katie S. Murray, DO, MS, professor of urology at New York University Grossman School of Medicine chief of the Urology Service at Bellevue Hospital Center, New York, New York, for a comprehensive, case-based discussion on modern testicular cancer management, with a focus on thoughtful risk stratification, multidisciplinary collaboration, and surgical judgment in challenging clinical scenarios.

Murray walks through key principles in evaluating patients with seminoma and nonseminomatous germ cell tumors, including how tumor markers, histology, and pre-chemotherapy imaging shape treatment pathways. She highlights the unique role of PET imaging in the post-chemotherapy seminoma setting, where surveillance can often be safely pursued, while reinforcing why surgery remains essential for residual disease in nonseminomatous tumors.

The conversation explores complex post-chemotherapy decision-making, including how to interpret residual masses, when observation may be appropriate, and how intraoperative assessment can influence the extent of resection. Murray shares practical insights into surgical planning, lymph node template selection, management of pelvic and low retroperitoneal disease, and strategies to minimize vascular and bowel complications.

Beyond operative technique, the episode addresses patient counseling, including expectations around fertility, anejaculation, and postoperative complications such as chyle leak. The discussion also covers high-stakes scenarios such as desperation RPLND, emphasizing that these cases require multidisciplinary consensus, careful imaging review, and an all-or-none surgical approach.

Murray closes with advice for trainees and practicing clinicians alike: Know the guidelines, prepare deliberately for each case, and never manage testicular cancer in isolation. With its blend of technical pearls and big-picture perspective, this episode offers practical guidance for clinicians caring for patients across the full spectrum of testicular cancer.