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  • Review Article
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Organ-sparing approaches for testicular masses

Nature Reviews Urology volume 7, pages 454–464 (2010)Cite this article

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Abstract

Organ-sparing approaches are currently practiced in urology for many malignancies. Partial orchiectomy of germ cell tumors (GCT) provides potential benefits over radical surgery by reducing the need for androgen substitution, lessening psychological stress, and preserving fertility, with a durable cure rate. Furthermore, many testicular lesions detected clinically or by ultrasonography will be benign, in which case radical orchiectomy represents overtreatment. Partial orchiectomy for benign lesions allows preservation of endocrine and exocrine function, and reduced risk of local recurrence. However, selection criteria are not clear and one must always be suspicious that a GCT might exist. Carcinoma in situ that remains in the salvaged testicle is a challenge to treat. Radiation therapy is an option, although there is a high chance that patients will subsequently require hormonal replacement. Partial orchiectomy should be undertaken only in selected patients—men with bilateral testicular cancer or GCT in a solitary testis—if the size and location of the mass are amenable to surgery. Informed patient consent discussing radical orchiectomy as the gold standard is mandatory, and discussion of the risks associated with CIS and its treatment, as well as the need for androgen supplementation are paramount. Alternative strategies of organ preservation, such as radiotherapy, HIFU and chemotherapy, might be appropriate treatment options in the future. However, the safety and efficacy of these procedures needs to be demonstrated in comparison with partial orchiectomy in larger and prospective studies with longer follow-up.

Key Points

  • Partial orchiectomy of germ cell tumors (GCT) provides potential benefits over radical surgery by reducing the need for androgen substitution, lessening psychological stress, and preserving fertility, with a durable cure rate

  • Partial orchiectomy of benign testicular lesions reduces the proportion of patients overtreated with radical orchiectomy

  • Partial orchiectomy should be undertaken only in selected cases (bilateral testicular cancer or tumor in a solitary testis) at centers with sufficient experience of testicular cancer

  • Informed patient consent is mandatory, including discussion of radical orchiectomy as the gold standard, explanation of carcinoma in situ (CIS) and potential adjuvant treatment, and the possible need for androgen supplementation

  • Adjuvant radiation is not mandatory for patients with CIS but fertility issues and anxiety should be accounted for, along with a willingness to accept self-examination and imaging follow-up

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Figure 1: Ultrasonography of a small palpable testicular mass located at the lower pole of the testis.
Figure 2: Partial orchiectomy.

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Acknowledgements

We acknowledge the contribution of Janice Yau, a Biomedical Communications student at the University of Toronto, Toronto, Canada for creating the original artwork for Figure 2.

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Department of Surgical Oncology, Division of Urology, Princess Margaret Hospital and the University Health Network, University of Toronto, 610 University Avenue, 3–124, Toronto, M5G 2C4, ON, Canada

    Alvaro Zuniga, Nathan Lawrentschuk & Michael A. S. Jewett

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Zuniga, A., Lawrentschuk, N. & Jewett, M. Organ-sparing approaches for testicular masses. Nat Rev Urol 7, 454–464 (2010). https://doi.org/10.1038/nrurol.2010.100

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