639 TESTIS-SPARING SURGERY FOR PRESUMED TESTICULAR MALIGNANCY IN PATIENTS WITH PRIOR GERM CELL TUMORS OR A SOLITARY TESTICLE- A LARGE NORTH AMERICAN EXPERIENCE

Abstract

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease II1 Apr 2010639 TESTIS-SPARING SURGERY FOR PRESUMED TESTICULAR MALIGNANCY IN PATIENTS WITH PRIOR GERM CELL TUMORS OR A SOLITARY TESTICLE- A LARGE NORTH AMERICAN EXPERIENCE Nathan Lawrentschuk, Alvaro Zuniga, and Michael Jewett Nathan LawrentschukNathan Lawrentschuk More articles by this author , Alvaro ZunigaAlvaro Zuniga More articles by this author , and Michael JewettMichael Jewett More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Testis-sparing surgery (TSS) for imperative indications such as a metachranous germ cell tumor or in a solitary testicle is becoming a more accepted option to minimize functional, physical and psychological morbidity as data accumulates that oncologic outcome is rarely compromised. As most data originates from Europe, our objective was to review our institutional experience in North America. METHODS We identified men in our institutional database having testis-sparing surgery for presumed testicular malignancy that had prior germ cell tumors (GCT) or a solitary testicle between 1994 and 2009. Demographic, clinical, pathological and outcome data were identified. Patients who were found to have malignant neoplasms and therefore risk of metastases were followed with physical examination, serum markers and imaging. RESULTS 27 men fulfilled the criteria (median age 34 years) with the median ultrasound lesion size was 10mm (range 5-28mm) with location split evenly between upper mid an d lower poles of the testes. 24 men had metachronous lesions with 3 lesions in solitary testes. 17 men (63%) had malignant lesions (9 seminoma, 3 teratoma, 1 embryonal, 3 leydig cell and 1 CIS) whilst 10 (37%) had benign pathology. The median follow-up was 4 years (0.5-10.4 years) in men with malignant lesions. CIS was seen in 38% patients with GCT. Testosterone substitution was observed in 31% patients treated with POs. Follow-up found local recurrence in 2 patients despite clear margins with both undergoing radical orchiectomy and one having chemotherapy. One further patient had distant recurrence in an embryonal carcinoma with a retroperitoneal node (2 cm) and negative serum markers at 4 months of follow-up necessitating RPLND with embryonal cancer in a solitary node. One patient with seminoma and the CIS only patient both elected to have radiation and both have normal testosterone levels. The other 5 patients with CIS were underwent surveillance. CONCLUSIONS TSS is an option in men with imperative indications to reduce morbidity but is potentially associated with recurrence, the need for adjuvant treatment and androgen substitution. Clearly a definite benefit of TSS is that a significant proportion of our patients (48%) with suspicious testicular lesions did not have GCT and were managed definitely with an organ-sparing approach. Toronto, Canada© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e251 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Lawrentschuk More articles by this author Alvaro Zuniga More articles by this author Michael Jewett More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...