Radical orchidectomy for suspected testicular cancer: Is preoperative staging computed tomography justified?

Abstract

The standard of care for men with a suspected malignant testicular tumour and normal contralateral testis is radical orchidectomy, testicular tumour markers and computed tomography scan staging. If the definitive orchidectomy histopathology is benign, young men are potentially exposed to unnecessary radiation. We sought to establish the rate of benign pathology returned from radical orchidectomy at our local urology multidisciplinary team (MDT) and if there were any preoperative factors suggestive of benign lesions. We included patients discussed at our local MDT meeting regarding testicular tumours with histology following radical orchidectomy between 1 January 2016 and 31 December 2018. A total of 113 patients were included, with benign histology following radical orchidectomy in seven (6.2%) patients. The benign histology included one adenomatoid tumour, and the remainder showed features of either infarction or inflammation. Metastases were detected on staging imaging in 21% of patients. Of these, 64% had normal preoperative tumour markers. Neither tumour size nor number of preoperative ultrasounds correlated with a risk of benign histology. One patient had chemotherapy prior to orchidectomy. It was reassuring that just 6.2% of patients had benign histology with no significant factors predictive of benign histology. This supports pre-orchidectomy staging imaging and the current MDT pathway for suspected testicular cancers. Level of evidence: Level 2C.