Oncology - Bladder, Renal, Test
Mid-Atlantic Section 76th Annual Meeting
Introduction & Objective :
Recent studies have demonstrated a significantly higher risk of benign pathology for non-palpable subcentemeter testicular masses diagnosed with higher-resolution testicular ultrasound. Recent studies have advocated for surveillance rather than proceeding to radical orchiectomy to avoid the overtreatment of benign testicular tumors. Our aim was to determine our institution’s rate of benign pathology based on testicular mass size, identify predictors of benign pathology, as well as review our experience with partial orchiectomy.
Retrospectively, we reviewed our institutional testicular cancer database to evaluate patients who underwent a radical or partial orchiectomy for a suspicious testicular mass seen on ultrasound between 2003-2017. We evaluated tumor histology based on maximum diameter after orchiectomy, preoperative radiographic and patient characteristics associated with benign pathology, and reviewed our patients who underwent partial orchiectomy.
We identified 272 patients who underwent a partial or radical orchiectomy for a testicular mass. Overall, 26 patients (9.6%) had benign pathology. Tumors ≤ 0.5cm and ≤ 1cm had a benign rate of 50% and 35%, respectively with a significantly decreasing rate of benign pathology as tumor size increased (Figure 1). Age and testicular cancer risk factors (infertility, prior history of testicular cancer, cryptorchidism, infertility) were not predictive of benign pathology with the exception of the absence of elevated tumor markers (OR 13.5, 95%CI 1.8-101.6, p=0.01). Smaller tumor size (OR 1.7, 95%CI 1.2-2.4, p=0.002), tumor volume (OR 1.06, 95%CI 1.1-1.0, p=0.04), and percentage of total testicular volume (OR 16.5, 95%CI 1.4-194.0, p=0.03) were significantly associated with benign pathology. 17 patients (6.2%) attempted a partial orchiectomy with 7 patients (41.1%) being converted to a radical orchiectomy for germ cell tumor identified on frozen section intraoperatively.
Testicular masses ≤ 1cm had a high benign rate after orchiectomy, however the majority of masses were germ cell tumors. Partial orchiectomy remains a feasible treatment option to reduce the overtreatment of benign tumors while avoiding a delay in the definitive surgical management of testicular cancer.