Management of small testicular masses: outcomes from a single centre multidisciplinary team.

To report the management outcomes of men with a <20mm smaller testicular masses (STMs) and to identify any clinical and histopathological factors associated with malignancy.

A retrospective analysis of men managed at a single-centre between Jan 2010 and Dec 2020 with a STM <20mm was performed.

Overall, 307 men with a median (IQR) age of 36 (30-44) years were included. 161 (52.4%), 82 (26.7%), 62 (20.2%) and 2 (0.7%) men underwent surveillance with interval ultrasound scan (USS), primary excisional TB, primary RO, or were discharged respectively. The median (IQR) surveillance duration was 6 (3-18) months. Majority of men who underwent surveillance had lesions <5mm (59.0%) and no lesion vascularity (67.1%) on USS. 33 (20.5%) men under surveillance had a TB due to changes on interval USS or patient choice, 7 (21.2%) were found to be malignant. The overall malignancy in the surveillance cohort was 4.3%. The majority of men who underwent primary RO had lesions >10mm (85.5%) and presence of vascularity (61.7%) on USS. 19 (23.2%) men who underwent primary TB (median lesion size, 6mm) had a malignant biopsy and underwent a RO. 88 (28.7%) men underwent RO and malignancy was confirmed in 73 (83.0%) of these cases. The overall malignancy rate in the whole STM cohort was 23.8%. Malignant RO specimens had significantly larger lesions sizes (median (IQR) 11 (8-15) mm; vs benign, 8 (5-10) mm; p=0.04).

STMs can be stratified and managed based on lesion size and USS features. The overall malignancy rate was 23.8% in men with a STM (4.3% in the surveillance group). Surveillance should be considered in lesions <10mm, and with a TB or FSE offered prior to RO to preserve function.

BJU international. 2022 Aug 20 [Epub ahead of print]

Shafi Wardak, Karl H Pang, Fabio Castiglione, Jamie Lindsay, Miles Walkden, Dan Heffernan Ho, Alex Kirkham, Paul Hadway, Raj Nigam, Rowland Rees, Hussain M Alnajjar, Constantine Alifrangis, Asif Muneer

Department of Urology, Royal Berkshire NHS Foundation Trust., Male Genital Cancer Centre, Institute of Andrology, University College London Hospitals NHS Foundation Trust., Department of Radiology, University College London Hospitals NHS Foundation Trust., Department of Medical Oncology, University College London Hospitals NHS Foundation Trust.