Incidental detection of urogenital tumors has increased in recent decades owing to the greater use of ultrasonography and cross-sectional imaging. For patients with low-risk prostate cancer or small renal masses, active surveillance represents a valid treatment option. Similarly, for men with small testicular masses <10 mm, active surveillance has been discussed as an alternative to surgery, although little is known regarding the behavior of small testicular germ cell tumors (GCTs). In the Swiss Austrian German Testicular Cancer Cohort Study we identified 849 patients (546 seminoma, 303 nonseminoma) treated with radical inguinal orchiectomy for GCT with a median tumor diameter of 35 mm. A tumor diameter <10 mm was observed in 25 patients (13 seminoma, 12 nonseminoma). Of these, five patients (20%) presented with primary metastatic disease, all of whom had elevated tumor markers and nonseminomatous GCTs. Two patients (8%) with initially localized disease (1 seminoma, 1 nonseminoma) and without elevated tumor markers experienced relapse at 4 mo (nonseminoma) and 14 mo (seminoma) after orchiectomy, despite the fact that the latter had received adjuvant chemotherapy. These findings highlight the metastatic potential of small testicular GCTs and raise the question of whether active surveillance for small testicular masses is safe.
This study on testicular cancer assesses the metastatic potential of small testicular germ cell tumors. Men with small testicular masses should be counseled about the malignant potential of small testicular germ cell tumors.
European urology open science. 2022 Apr 26*** epublish ***
Manolis Pratsinis, Christian Fankhauser, Katerina Pratsinis, Jörg Beyer, Emanuel Bührer, Richard Cathomas, Natalie Fischer, Thomas Hermanns, Anita Hirschi-Blickenstorfer, Jörn Kamradt, Luis Alex Kluth, Deborah Zihler, Walter Mingrone, Beat Müller, Tim Nestler, Sacha I Rothschild, Bettina Seifert, Arnoud J Templeton, Angelika Terbuch, Mark-Peter Ufen, Regina Woelky, Silke Gillessen, Christian Rothermundt
Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland., Department of Urology, Kantonsspital Luzern, Luzern, Switzerland., Department of Computational Biology and Bioinformatics, ETH Zurich, Zurich, Switzerland., Department of Medical Oncology, Inselspital, University Hospital, University of Bern, Bern, Switzerland., Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland., Department of Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland., Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Onkozentrum Hirslanden, Klinik Hirslanden, Zurich, Switzerland., Zentrum für Urologie und Nephrologie Bern, Bern, Switzerland., Department of Urology, University Medical Center Frankfurt, Frankfurt am Main, Germany., Department of Medical Oncology and Hematology, Kantonsspital Aarau, Switzerland., Onkologiezentrum, Kantonsspital Olten, Switzerland., Medizinische Onkologie, Luzerner Kantonsspital, Luzern, Switzerland., Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany., Department of Medical Oncology and Comprehensive Cancer Center, University Hospital Basel, Basel, Switzerland., Onkologie Kantonsspital Baselland, Liestal, Switzerland., Department of Oncology, St. Claraspital Basel, Basel, Switzerland., Abteilung für Onkologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Austria., Ammerland-Klinik GmbH, Westerstede, Germany., Medizinische Onkologie, Kantonsspital Frauenfeld, Frauenfeld, Switzerland., Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland., Department of Medical Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.