Organ-sparing surgery in testis cancer: Fact or fiction?

04 October 2015

The incidence of testis cancer has increased by 40% in the last four decades  particularly in men younger than 35 years, a patient population that is at the peak of their reproductive age which prompts many doctors to consider organ-sparing options.

“Patient assessment for organ-sparing in testis cancer is crucial, and patient and history taking is very important not only in the diagnosis of testis cancer, but also in patient selection for an organ-sparing option (OSS),” said Z. Kopa (HU) in an update lecture on testis cancer during the 15th Central European Meeting held in Budapest.

“There are strong arguments for organ-sparing such as the high accuracy in frozen section examination (FSE) which is around 100%, and the increasing attention paid to the cosmetic, functional, and psychological outcomes of patients with testicular tumours,” added Kopa, although he noted that the literature lacks studies with a high level of evidence in comparing OSS with radical surgery.

He also cited the EAU Guidelines recommendations on the issue of organ-sparing, a topic which he said is often overlooked in actual practice.

“According to the EAU Guidelines , an organ-sparing surgery surgery (OSS) can be attempted in special cases and should be performed at experienced centers,” said Kopa.

Surgical removal of the tumorous organ or testis is the most common option in testis cancer to rule out or minimize metastatic disease.

Kopa, however, noted that organ-sparing procedures such as micro-surgery is a viable option in cases of solitary tumors, negative markers, with a careful monitoring of the residual testis and the careful consideration of fertility aspects.

He also emphasised the role of patient counselling, as he noted that patients need thorough information to guide their decision-making.