Synchronous bilateral testis cancer: clinical and oncological management

Abstract

Synchronous bilateral testis cancer (SBTC) is a rare event. It represents only 0.5–1% of all new cases of testicular cancer. Patients with this disease require careful management for psychological, oncological, and medical problems.We performed a PubMed search for all series that reported SBTC. We considered only articles in English, reporting on more than three cases. We also performed an analysis of the reported evidence regarding testosterone replacement and surgical treatment.We found 10 studies satisfying inclusion criteria for a total of 73 patients. The majority are bilateral seminoma, which present with a low stage at diagnosis, and mixed histology tumours, both with a good overall survival. On the other hand, cases with bilateral non-seminoma histology are associated with poor prognosis and high stage at presentation.Testis-sparing surgery should be an eligible choice in selected cases, to preserve fertility and avoid testosterone deficiency. Multiple biopsies are recommended in these patients, and in the case of intratubular germ cell neoplasia (ITGCN) presence, scrotal radiotherapy is mandatory. Subcutaneous testosterone pellets guarantee higher patient acceptance and physiological testosterone levels. Lifelong follow-up and psychological support, with special care for infertility and erectile dysfunction, must be considered in this cohort of patients.

Bilateral synchronous testicular seminoma: A rare presentation of a rare disease

“…Only one patient had local recurrence 9 months after tumor enucleation. Testis-sparing surgery must be performed whenever possible, when tumor volume is less than 30% of the testicular volume and surgical margins are respected (1), although multiple testicular biopsies are advocated in this setting in order to identify the presence of CIS and tumor multifocality (1). The occurrence of CIS is a factor suggesting the need for irradiation therapy which can result in loss of fertility and hormonal function of the remaining part of the testicle, the important factors affecting patients' quality of life (1).…”

“…Testicular germ cell tumors (TGCTs) are the most common malignancy diagnosed in males aged 20 to 40, nevertheless they are a rare disease representing only 5% of all urologic tumors (1). Risk factors in the development of testicular tumors include history of cryptorchidism or undescended testis, Klinefelter syndrome, testicular cancer in the first-degree relatives, presence of tumor or intratubular germ cell neoplasia (TIN) in the contralateral testis, and infertility (1).…”

“…Risk factors in the development of testicular tumors include history of cryptorchidism or undescended testis, Klinefelter syndrome, testicular cancer in the first-degree relatives, presence of tumor or intratubular germ cell neoplasia (TIN) in the contralateral testis, and infertility (1). Bilateral TGCTs (BTT) are even more rare, representing 1-2% of all cases at diagnosis.…”

“…Bilateral TGCTs (BTT) are even more rare, representing 1-2% of all cases at diagnosis. Approximately 35% of these bilateral tumors are synchronous and the majority are seminomas, being histologically identical almost always (1). Management of this tumors is controversial.…”

“…terone levels (1). In order to preserve fertility and androgen production, organ-sparing surgery can be attempted when tumor volume is less than 30% of the testicular volume and surgical rules are respected (1).…”