New technique for identifying and treating testicular cancer

A new surgical technique, pioneered by doctors in the US may make it possible for more men with testicular tumors to avoid having the affected testicle removed, thus saving their fertility.

According to a report in a recent issue of the Journal of Urology, the technique allows doctors to identify and remove benign and malignant tumors and preserve the testis when the tumor is benign. It could also allow the testicle to be preserved in some men with small malignant tumors.

Tumors in the testicles are usually identified by physical examination, but doctors have not developed clear guidelines for diagnosing and treating smaller, harder to find tumours that are identified by ultrasound scans performed for other purposes, such as for evaluating fertility.

“Traditionally, when a man is discovered to have a hidden testicular tumour, the recommendation is radical orchiectomy, the removal of the testicle,” Dr. Marc Goldstein of New York-Presbyterian Hospital Weill Cornell Medical Center in New York City said.

“We now know, by using guided needle localisation, that half of all these tumours are benign,” added Goldstein, who is a co-author of the new study.

“Therefore, as many as half of men diagnosed with impalpable testis tumours may have a testis removed unnecessarily. This is particularly devastating for men with only one testis to start with. Our new technique makes correct diagnosis possible,” the researcher said.

The technique uses an ultrasound-guided needle to pinpoint the location of the tumor. Once the tumour has been located, an operating microscope is used to examine the tumour and guide its removal. Patients are able to return to work within three days of having the procedure.

The study is the first to report on the use of an operating microscope to help in the removal of such tumours.

Sixty-five men undergoing fertility evaluation took part in the current study. Of the group, four men were found to have hidden testicular tumours. Two of the men had benign tumours and were able to avoid further surgery. The other two had malignant tumours and opted to have their testicle removed.

Dr. Goldstein and his colleague Dr. Carin V. Hopps note that the new diagnosis and removal technique could also be used, in some cases, to remove small malignant tumours, allowing the testicle to be saved.

(Source: ASCO)