Department of Urology, CHRU Lille, Lille university, Lille, France.
Introduction: Radical orchiectomy is the standard treatment for a testis cancer. Partial orchiectomy (PO) can be considered in the setting of a solitary functioning testis, bilateral tumors or for small testicular lesions.
Objective: To evaluate possible factors predicting testicular cancer in patients undergoing PO. Methods: We retrospectively analyzed the records of all patients who underwent PO for a solitary functioning testis, bilateral tumors or a small lesion ( <2cm on preoperative ultrasound) in our center during the period 2004-2021. Testis sparing surgery consisted of tumor enucleation for FSE. Immediate radical orchiectomy was performed in all cases of malignancy at FSE but otherwise the testes were spared. Results: 101 patients were included in the study. Reasons for PO included small lesion in 79 (78%); solitary functioning testis in 18 (18%) or bilateral lesions in 4 (4%). A lesion was palpable in 32 (32%) and median size was 6.6mm (IQR=5.2-10) at US. 21 patients had elevated serum tumor markers. Overall 28 of the 101 men (28%) presented with testicular cancer (20 seminomas, 6 non-seminomas,1 germ cell neoplasia in situ and 1 burn-out tumor). Diameter of the lesion (p < 0.05), presence of microlithiasis (p < 0.01), irregular contour of the lesion (p < 0.01) on preoperative US, elevated serum markers (p < 0.05), personal history of testicular cancer (p < 0.01) were predictors of malignancy (table 1). Conclusions: Small testicular masses are often benign and do not always require radical orchiectomy. None of the predictive factors can preoperatively predict the histology of the lesion. Therefore, we suggest to perform partial orchiectomy for small testicular masses. SOURCE OF Funding: none
