Recommendations for the management of indeterminate small testis masses

Currently, the pathway for the management of indeterminate small testis masses is not standardised. The current study assessed the outcomes including imaging surveillance and biopsy of small testis masses to propose a management pathway for small testis masses to avoid unnecessary radical orchidectomy. This study has important implications relating to the preservation of fertility and hormonal function.

In a retrospective analysis of all small testis masses (≤2 cm) from a single centre in the United Kingdom over a 10-year period, each case was discussed by a specialist testis multidisciplinary team [1]. The current analysis included 307 patients (median age 36 years) with a median lesion size of 6 mm (range 1.5–20 mm). Of these, 62 patients (20%) underwent radical orchidectomy, 161 (52%) underwent surveillance with serial ultrasounds up to 12 months, 82 (27%) had an ultrasound-guided testicular biopsy, and 3 (1%) were discharged with reassurance and advice for self-examination.

A total of 115 patients (38%), including 33 patients from the surveillance cohort, underwent a testicular biopsy. Of these patients, 30 (26%) had a histological diagnosis of malignancy. Most malignancies were seminomas, and the remainder were benign lesions including Leydig cell tumours. Tumour markers were not elevated in any of the patients with malignancy.

Orchidectomy for small testis masses has significant implications for fertility and hormonal function. This study showed that <10% of small testis masses were malignant. The cancer detection rate for patients under surveillance was even lower (4.3% in this analysis). Surveillance can avoid unnecessary biopsy and orchidectomy while ensuring that the lesions that change are biopsied early.

Based on this data, Mr Shafi Wardak (University College London Hospitals, UK) argued that all small testis masses should be reviewed in a testis multidisciplinary team before considering surgical intervention. He recommended ≥3 surveillance scans 3–6 months apart, and to biopsy the lesions that change on serial imaging.

1. Wardak SW. Management of indeterminate Small Testis Masses (STMs): A 10-year single centre experience. P0654, EAU21 Virtual, 8–12 July 2021.

 

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Posted on 31 August 2021