Routine scrotal ultrasonography during the follow‐up of patients with testicular cancer leads to earlier detection of asynchronous tumours and a high rate of organ preservation

Abstract

Study Type – Diagnosis (case series) Level of Evidence 4OBJECTIVETo compare outcomes of patients with asynchronous tumours detected before and after the introduction of scrotal ultrasonography (SUS) during routine follow‐up examinations.PATIENTS AND METHODSSince January 2001 SUS was also used during the follow‐up of patients with testicular cancer. A series of 16 consecutive patients with asynchronous bilateral testicular tumours diagnosed while still complying with routine follow up investigations were identified and divided into two groups; group A was diagnosed by palpation only, before 2001, and group B was diagnosed after 2000. The groups were compared statistically for the interval between asynchronous tumours, clinical stage, tumour diameter at the time of diagnosis and rate of testis‐sparing surgery.RESULTSAll tumours in group A were diagnosed by palpation, but only two in group B were palpable at the time of diagnosis. The mean tumour diameter was statistically significantly smaller in group B (1.2 cm) than in group A (2.68 cm); testis‐sparing surgery was used in all of group B and only three patients in group A. After organ‐sparing surgery all patients had normal testosterone levels. All patients after organ‐sparing surgery had adjuvant scrotal radiotherapy because of germ cell tumour, and no patient had a local recurrence.CONCLUSIONOur data indicate that using SUS for the remaining testicle in routine follow‐up visits of patients with testicular cancer leads to the earlier detection of smaller tumours and, consequently, a higher rate of organ preservation. The maintenance of physiological endocrine function might finally result in a better quality of life.

Contemporary diagnostic work-up of testicular germ cell tumours

“…54 Malignancy is associated with masses >1 cm, and clinical risk parameters of GCT (Table 1) can be helpful in predicting malignancy. 55 Notably, lesions that are hyperechoic on ultrasonography tend to be benign, representing instead intratesticular calcifications or scars. 22,23 In the near future, it is likely that multiparametric ultrasonography 21,53 -the sequential use of greyscale ultrasonography, CDUS, PDUS, and, if available, CEUS and RTE-will be used to accurately identify those testicular masses that require surgery.…”

Organ-sparing approaches for testicular masses

“…75 Secondly, vigilant follow-up of men with a solitary testis using ultrasonography has been suggested, to ensure earlier detection of smaller tumors, which might result in a higher rate of organ preservation. 76 Thus, the benefits of organ-sparing treatment can be experienced by patients for whom self-examination was traditionally recommended, unless there were indications to biopsy the remaining testicle. Biopsy for contralateral CIS is not always practiced, owing to the fact that selfexamination is easy to teach, and resultant tumors are amenable to correction.…”

Testis-Sparing Surgery in Patients with Germ Cell Cancer: Indications and Clinical Outcome

“…This was shown in a retrospective analysis after introducing ultrasound into the follow-up schedule [5]. In a limited number of patients in whom the tumor was detected by palpation compared to a patient cohort in whom ultrasound was implemented in the follow-up, the mean tumor size was 1.2 (0.5-2.5) cm versus 2.68 (0.6-5.5) cm (p = 0.031).…”