OBJECTIVE: To review long term oncological and functional outcomes of testicular-sparing surgery (TSS) in men presenting with bilateral or monorchide testicular tumor among five reference centers for testicular neoplasm and infertility.
PATIENTS AND METHODS: We review 25 cases of bilateral synchrone and metachrone testicular tumors treated in five academic centers between 1984 and 2013. Clinical, biological, ultrasound, pathological tumor finding, overall survival (OS), local or metastatic recurrence, pre and post operative hormonal profile, paternity and the need for androgen substitution were assessed.
RESULTS: Eleven patients with a bilateral synchrone tumor and fourteen with a testicular tumor on a solitary testicle underwent a tumorectomy. Mean age was 31.9 ± 1.04 years old mean total testosterone level was 4.5 ± 0.57 ng.ml and mean tumor size was 11.66 ± 1.49 mm. Tumors were 11 seminoma, 9 non seminomatous or mixed germ cell tumors, 4 Leydig tumors, and one hamartoma. Frozen section examination was performed in 14 cases, and matched final pathological analysis in 11 cases. OS was 100% and 3 patients (12%) presented a local recurrence after a mean follow-up of 42.7 months. Radical orchiectomy was performed for 6 patients. No patient with a preserved testicle required androgen therapy; mean post-operative total testosterone level was 4.0 ng/ml. No patient could father a child after radiation therapy.
CONCLUSIONS: Sparing surgery for bilateral testicular tumor is safe and effective in selected patients, and should be considered to avoid definitive androgen therapy. Adjuvant radiotherapy remains poorly described leading to adjuvant treatment heterogeneity.
Written by:
Ferretti L, Sargos P, Gross-Goupil M, Izard V, Wallerand H, Huyghe E, Rigot JM, Durand X, Benoit G, Ferriere JM, Droupy S. Are you the author?
Department of Urology, University Hospital Pellegrin, Bordeaux, France; HIA Robert Picque, Departement of Surgery, Villenave d'Ornon.
Reference: BJU Int. 2013 Nov 1. Epub ahead of print.
doi: 10.1111/bju.12549
PubMed Abstract
PMID: 24180380
UroToday.com Testicular Cancer Section
