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Testis-sparing Surgery in Adult Patients with Germ Cell Tumors: Systematic Search of the Literature and Focused
Axel Heidenreich1, Felix Seelemeyer2, Bulent Altay2
1Department of Urology, Uro-Oncology, Robot Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Vienna, Austria.
Abstract:
Testis-sparing surgery (TSS) is a guideline-recommended treatment option for men with synchronous or metachronous bilateral testicular germ-cell tumor (GCT) or GCT in a solitary testicle. The tumor volume should not exceed 50% of the total testicular volume and serum concentrations of both testosterone and luteinizing hormone should be within the normal ranges. After tumor enucleation, patients should undergo adjuvant radiation of the testicle in case of germ cell neoplasia in situ. The local relapse rate is approximately 4% if TSS is performed properly. Physiological serum testosterone concentrations are achieved in more than 85% of patients, and approximately 50% of men with intact spermatogenesis can achieve paternity. The risk of systemic metastases is not increased by TSS. PATIENT SUMMARY: Testis-sparing surgery is the treatment of choice for men with testicular cancer in both testes or in men who have just one testis. In more than 85% of patients this approach results in maintenance of normal testosterone levels.
Insights
Testis-sparing surgery (TSS) offers a viable treatment for testicular germ-cell tumors (GCT) in select patients. This approach preserves testosterone levels in over 85% of men, with a low local relapse rate when performed correctly.
Area of Science:
- Urology
- Oncology
- Reproductive Medicine
Background:
- Testis-sparing surgery (TSS) is a recommended treatment for bilateral testicular germ-cell tumors (GCT) or GCT in a solitary testicle.
- Specific criteria include tumor volume ≤50% of testicular volume and normal hormone levels.
Purpose of the Study:
- To evaluate the efficacy and outcomes of testis-sparing surgery (TSS) for managing testicular germ-cell tumors (GCT).
Main Methods:
- Surgical enucleation of GCT, followed by adjuvant radiation for germ cell neoplasia in situ.
- Monitoring of serum testosterone, luteinizing hormone, and local relapse rates.
Main Results:
- Low local relapse rate of approximately 4% when TSS is performed according to guidelines.
- Maintained physiological serum testosterone concentrations in over 85% of patients.
- Paternity achievable in approximately 50% of men with preserved spermatogenesis; no increased risk of systemic metastases.
Conclusions:
- TSS is an effective and safe organ-sparing treatment for selected GCT patients.
- TSS preserves endocrine function and fertility potential, with a low risk of recurrence.
- Guideline adherence is crucial for optimal outcomes in testis-sparing surgery for GCT.
