Metastatic Potential of Small Testicular Germ Cell Tumors: Implications for Surveillance of Small Testicular Masses

Reply to Julian Chavarriaga and Robert Hamilton's Letter to the Editor re: Manolis Pratsinis, Christian Fankhauser, Katerina Pratsinis, et al. Metastatic Potential of Small Testicular Germ Cell Tumors: Implications for Surveillance of Small Testicular Masses. Eur Urol Open Sci 2022;40:16–8. Should We Be Afraid of Surveillance? Clinically Meaningful Reasons Why Offering Surveillance for Incidentally Detected Small Testicular Masses Remains a Safe Approach

“…On the other hand, surveillance requires repeated appointments for blood measurements and ultrasound, and may have a negative psychological impact on many men who do not require any follow-up at all. Our study [6] adds some evidence suggesting that there is indeed limited metastatic potential in men with STMs. This means that curative treatment with orchiectomy alone may be withheld and patients may later require systemic chemotherapy with its associated long-term toxicity.…”

Re: Manolis Pratsinis, Christian Fankhauser, Katerina Pratsinis, et al. Metastatic Potential of Small Testicular Germ Cell Tumors: Implications for Surveillance of Small Testicular Masses. Eur Urol Open Sci 2022;40:16–18

“…No one would advocate surveillance for patients with STMs and elevated tumor markers, so it is biased to draw conclusions about a de novo marker-negative STM population. In a similar vein, the median tumor size in the study was 8 mm [1] . This is substantially larger than the size observed by Toren et al (4.3 mm) [3] and Bieniek et al (4.1 mm) [4] , again speaking to the fact the cohort analyzed by Pratsinis et al should not be extrapolated to all newly presenting STMs.…”

“…Our second issue is that one-third of the patients in the study by Pratsinis et al had elevated tumor markers [1] . Of the seven patients they described with metastatic disease, five (71%) had elevated markers.…”

“…We read with great interest the article by Pratsinis et al [1] regarding a cohort of 849 patients who underwent orchiectomy for a malignant germ cell tumor and their specific analysis for masses <10 mm. Among the 25 such masses, five presented with metastases and two cases with initially localized disease experienced relapse.…”

“…Patients who underwent orchiectomy did so for a reason: either their surgeon was concerned or they were concerned about the malignant potential of their testicular mass. This concern may have come from the presence of elevated tumor markers, lesion growth on serial ultrasound, or certain lesion characteristics [1] . To assume that this highly selected set of STMs can be extrapolated to the behavior of all STMs is inaccurate.…”