From the Guidelines
Mild testicular microlithiasis generally requires only conservative management with annual testicular self-examinations and periodic ultrasound surveillance. For asymptomatic patients with incidentally discovered microlithiasis and no risk factors for testicular cancer, annual self-examinations are recommended, with follow-up ultrasounds typically performed every 1-2 years 1. Patients with additional risk factors for testicular cancer (such as cryptorchidism, prior testicular cancer, family history, or infertility) may require more frequent ultrasound monitoring, typically every 6-12 months.
Key Considerations
- No medications or interventional treatments are necessary for the microlithiasis itself, as these calcifications are benign.
- Patient education is essential, teaching proper testicular self-examination technique to detect any concerning changes.
- The conservative approach is justified because while microlithiasis has a statistical association with testicular cancer, the absolute risk remains low, and there is no evidence that the calcifications themselves are precancerous or that they progress to malignancy.
- The primary goal of management is appropriate surveillance to detect any potential malignancy early while avoiding unnecessary interventions for this common and typically benign condition.
Surveillance and Monitoring
- Scrotal ultrasound (US) with Doppler should be obtained in patients with a unilateral or bilateral scrotal mass suspicious for neoplasm 1.
- Testicular microlithiasis in the absence of solid mass and risk factors for developing germ cell tumor (GCT) does not confer an increased risk of malignant neoplasm and does not require further evaluation 1.
- Patients with normal serum tumor markers (STM) and indeterminate findings on physical exam or testicular US for testicular neoplasm should undergo repeat imaging in 6-8 weeks 1.
From the Research
Management Approach for Mild Testicular Microlithiasis
The management approach for mild testicular microlithiasis varies depending on the presence of risk factors and the individual patient's condition.
- For patients with isolated mild testicular microlithiasis and no additional risk factors, follow-up is not advised 2.
- Regular testicular self-examination is recommended for patients with mild testicular microlithiasis, especially for those with normal testes 3, 4.
- Annual ultrasound is advised for patients with risk factors, such as personal or family history of germ cell tumors, maldescent, orchidopexy, or testicular atrophy, up to the age of 55 2.
- If mild testicular microlithiasis is found with a testicular mass, urgent referral to a specialist center is advised 2.
- The role of surveillance with serial ultrasonography and measurement of tumor markers is still not clear, and the cost-effectiveness of such a strategy needs to be evaluated 3, 5.
- Individualized risk assessment, counseling, and a patient-centered approach provide the framework for the best quality of care for patients with mild testicular microlithiasis 6.
Risk Factors
Risk factors that may influence the management approach for mild testicular microlithiasis include:
- Personal or family history of germ cell tumors
- Maldescent
- Orchidopexy
- Testicular atrophy
- Subfertility
- History of contralateral testicular tumor
- History of cryptorchidism
Follow-up and Surveillance
The follow-up and surveillance strategies for patients with mild testicular microlithiasis depend on the presence of risk factors and the individual patient's condition.
- Regular testicular self-examination is recommended for patients with mild testicular microlithiasis 3, 4.
- Annual ultrasound is advised for patients with risk factors up to the age of 55 2.
- The use of routine ultrasound surveillance for patients with mild testicular microlithiasis who are at low risk for testicular cancer is not supported by recent recommendations 5.