Testis-Sparing Surgery: Balancing Cancer Control with Fertility Preservation

Abstract

Testicular cancer remains the most commonly diagnosed malignancy in young men of reproductive age, with a peak incidence between the ages of 25 and 29. In patients with testicular cancer, the presence of the disease as well as the treatment itself may lead to significant morbidity, resulting in profound psychological, reproductive, and endocrinological damage to patients. Unfortunately, the incidence of testicular cancer has been steadily increasing in the Western world, bringing to the forefront the concept of testis-sparing surgery. Following the dogma of never-compromising cancer control, testis-sparing surgery (TSS) has the potential of reducing morbidity while preserving functionality. In this chapter, we discuss the evolving concept of TSS and its various indications and applications. Given the emerging evidence of the benign nature of most small, non-palpable testicular masses and the obvious benefits of organ preservation, the indications for TSS continue to expand. Initial evaluation includes history, physical examination, as well as review of pertinent imaging. Tumor markers and hormonal assessment are relevant, while baseline semen analysis is essential in patients who still desire fertility. TSS follows the same classic oncological principles of radical orchiectomy, including inguinal exploration and cord control. While various techniques can be utilized for tumor excision, frozen section examination is crucial for optimal treatment. When applied to select patients, TSS is a reality that must not be denied.