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"Lumpectomy" seems OK for some testicular cancers

Testicular cancer is an aggressive disease and usually requires removal of the entire testicle. Austrian doctors have shown, however, that a less radical approach can be safe in some cases, sparing the bulk of the affected organ.

The strategy involves surgically removing just the tumor, which is then sent for examination under a microscope while the patient is still in the operating room. This is repeated with gradually wider excisions until the specimen shows that the cancerous tissue is completely removed, surrounded by a margin of normal tissue.

In an article in the medical journal Urology, Dr. Alfred Hobisch, from the General Hospital of Feldkirch in Austria, and others describe their experience with 30 patients who underwent the organ-sparing approach between August 1994 and May 2002.

To be a candidate for the operation, the patients had to have a tumor no greater than about an inch in diameter, and to have normal male hormone levels.

For most patients, the approach was successful in avoiding removal of the testicle, and did not result in low testosterone levels. However, one patient required removal of the remnant of the testicle because final microscopic examination of the removed specimen did not show normal margins, and another patient required it because of abnormal hormone levels.

After an average of nearly four years, all of the patients were free of disease, the team reports.

"To our knowledge, the general organ-sharing approach for all small testicular masses has not yet been described in published reports as a first-line treatment," Dr. Hobisch and colleagues note.

The technique is effective, helps to prevent lifelong hormone replacement, and may even preserve fertility in some patients, they conclude, "provided the criteria concerning patient selection and surgical technique are observed."



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