TY - JOUR
T1 - Management of Small Testicular Masses
T2 - A Delphi Consensus Study
AU - EAU-YAU Penile and Testis Cancer Working Group
AU - Pang, Karl H
AU - Fallara, Giuseppe
AU - Lobo, João
AU - Alnajjar, Hussain M
AU - Sangar, Vijay
AU - von Stempel, Conrad
AU - Huang, Dean Y
AU - Parnham, Arie
AU - Cazzaniga, Walter
AU - Giganti, Francesco
AU - Haider, Aiman
AU - Sachdeva, Ashwin
AU - Albersen, Maarten
AU - Alifrangis, Costi
AU - Bandini, Marco
AU - Castiglione, Fabio
AU - De Vries, Hielke-Martijn
AU - Fankhauser, Christian
AU - Heffernan Ho, Daniel
AU - Nicol, David
AU - Shamash, Jonathan
AU - Thomas, Anita
AU - Walkden, Miles
AU - Freeman, Alex
AU - Muneer, Asif
N1 - Publisher Copyright:
Copyright © 2024 European Association of Urology. All rights reserved.
PY - 2025/2/1
Y1 - 2025/2/1
N2 - 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.
AB - 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.
KW - Consensus
KW - Delphi
KW - Orchidectomy
KW - Small testicular mass
KW - Testicular cancer
KW - Testis-sparing surgery
UR - http://www.scopus.com/inward/record.url?scp=85218491443&partnerID=8YFLogxK
U2 - 10.1016/j.euo.2024.10.010
DO - 10.1016/j.euo.2024.10.010
M3 - Article
C2 - 39500644
SN - 2588-9311
VL - 8
SP - 152
EP - 163
JO - European Urology Oncology
JF - European Urology Oncology
IS - 1
ER -
