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Small Testicular Masses: Contemporary Diagnostic and Treatment Strategies, Future Directions, and Knowledge Gaps

Julian Chavarriaga1, Robert Hamilton1

  • 1Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.

Urologic Oncology
|March 29, 2023
PubMed

Insights

Small testicular masses in young men are common, with malignancy rates lower than previously believed. This review guides diagnosis and management, distinguishing between tumors needing treatment and benign lesions for surveillance.

Area of Science:

  • Urology
  • Oncology
  • Diagnostic Imaging

Background:

  • Incidental discovery of small testicular masses is a growing clinical challenge.
  • Malignancy rates for testicular masses ≤ 2 cm are lower than historically assumed, potentially 13-21%.

Purpose of the Study:

  • To review current evidence on diagnostic work-up and treatment for small testicular masses.
  • To discuss surveillance strategies, including selection criteria and follow-up for these lesions.

Main Methods:

  • Narrative review of scientific literature.
  • Analysis of diagnostic and treatment strategies.
  • Experience from a dedicated testicular cancer clinic.

Main Results:

  • Malignancy rates for small testicular masses are lower than previously thought.
  • Distinguishing between malignant and benign small testicular masses is crucial for appropriate management.
  • Surveillance protocols can be safely applied to select patients with small testicular masses.

Conclusions:

  • A lower threshold for surveillance is appropriate for small testicular masses.
  • Careful patient selection, diagnostic work-up, and follow-up are essential.
  • Recommendations are provided for assessing and managing small testicular masses.
Keywords:
Neoplasms, Germ cell and embryonalNonseminomatous germ-cell tumorsOrchidectomySeminomasTesticular cancerUltrasound

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