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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.
Background And Objective:
The majority of small testicular masses (STMs) are benign and therefore radical orchidectomy (RO) may represent overtreatment. In appropriately selected patients, surveillance or testis-sparing surgery (TSS) is an alternative option to preserve testicular function. Since there are no clear guidelines, we aimed to develop consensus recommendations on the management of STMs.
Methods:
A four-round Delphi study was conducted by 24 experts representing multiple subspecialties to reach consensus. Consensus was defined as ≥75% of the participants scoring within the same 3-point grouping (1-3, disagree; 4-6, uncertain; 7-9, agree.). The first two rounds were survey based, the third round was an online meeting to discuss uncertainties from the first two rounds, and the fourth round was a review of the final consensus statements from rounds 1-3.
Key Findings And Limitations:
The initial survey consisted of 126 statements. Following the four rounds of assessment, a list of 96 statements were produced, which focused on clinical and biochemical assessment, colour Doppler ultrasound (CDUS) characteristics, and management options including surveillance, RO, and TSS. Management should be personalised according to risk factors for testicular cancer, fertility status, uni- or bilateral tumours, status of the contralateral testis, and CDUS characteristics, with solid lesions displaying vascularity and hypoechogenicity being more suspicious for malignancy. The consensus statements are prone to a bias, and some may not reflect robust, randomised evidence.
Conclusions And Clinical Implications:
The expert panel has produced consensus recommendations on the management of STMs, and TSS should be considered in patients with an STM. The recommendations could aid in the dissemination of best practice.
Patient Summary:
There are no clear guidelines on the management of small testicular masses. Excising the whole testicle (radical orchidectomy) with a small or an indeterminate mass may affect fertility and hormonal function. A panel of experts was formed, and consensus recommendations were developed on how to deal with small and indeterminate testicular masses, which include surveillance or testis-sparing surgery.
Insights
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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