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Management of Small Testicular Masses: A Delphi Consensus Study
Karl H Pang1, Giuseppe Fallara2, João Lobo3
1Department of Andrology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
European Urology Oncology
|November 5, 2024
Summary
Radical orchidectomy for small testicular masses may be overtreatment. Consensus recommendations favor personalized management, including surveillance or testis-sparing surgery (TSS), to preserve testicular function.
Area of Science:
- Urology
- Oncology
- Radiology
Background:
- Small testicular masses (STMs) are frequently benign, making radical orchidectomy (RO) potentially overtreatment.
- Preserving testicular function through surveillance or testis-sparing surgery (TSS) is crucial for selected patients.
- Lack of clear guidelines necessitates expert consensus for STM management.
Purpose of the Study:
- To develop consensus recommendations for the management of small testicular masses (STMs).
- To provide guidance on selecting appropriate management strategies, balancing cancer risk with testicular function preservation.
Main Methods:
- A four-round Delphi study involving 24 multidisciplinary experts.
- Consensus defined as ≥75% agreement within a 3-point grouping.
- Iterative survey rounds, an online meeting, and final statement review.
Main Results:
- Developed 96 consensus statements covering assessment and management of STMs.
- Personalized management based on cancer risk, fertility, tumor characteristics, and ultrasound findings.
- Solid, hypoechoic, vascular lesions are more suspicious for malignancy.
Conclusions:
- Expert consensus provides recommendations for STM management.
- Testis-sparing surgery (TSS) should be considered for STMs.
- These recommendations aim to disseminate best practices and improve patient outcomes.
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