From the Guidelines
The management plan for a patient with mild testicular microlithiasis primarily involves surveillance with annual testicular self-examinations and consideration of periodic ultrasound monitoring, as it is generally considered a benign condition that does not confer an increased risk of malignant neoplasm in the absence of a solid mass or other risk factors for germ cell tumor (GCT) 1.
Key Considerations
- Patients should be educated on proper testicular self-examination technique, performing it monthly to detect any changes in testicular size, consistency, or the development of palpable masses.
- For most patients with isolated mild testicular microlithiasis and no additional risk factors, an ultrasound follow-up every 1-2 years is reasonable, though the optimal frequency remains somewhat controversial 1.
- If the patient has additional risk factors for testicular cancer (such as cryptorchidism, family history of testicular cancer, personal history of testicular cancer, or infertility), more frequent ultrasound monitoring may be warranted, typically every 6-12 months 1.
Rationale
- The goal of surveillance is to detect any potential malignancy early while avoiding unnecessary interventions for what is typically a benign finding.
- Testicular microlithiasis itself is not harmful, but it has been associated with a slightly increased risk of testicular cancer in some studies, though the absolute risk remains low 1.
Important Notes
- Scrotal ultrasound with Doppler should be obtained in patients with a unilateral or bilateral scrotal mass suspicious for neoplasm 1.
- Serum tumor markers (STM) (alpha-fetoprotein [AFP], human chorionic gonadotropin [hCG], lactate dehydrogenase [LDH]) should be drawn and measured prior to any treatment, including orchiectomy, in patients with a solid mass in the testis suspicious for malignant neoplasm 1.
From the Research
Management Plan for Mild Testicular Microlithiasis
The management plan for a patient with mild testicular microlithiasis involves the following:
- Follow-up is not advised in patients with isolated testicular microlithiasis in the absence of risk factors 2, 3, 4
- Annual ultrasound (US) is advised for patients with risk factors, up to the age of 55 2
- If testicular microlithiasis is found with a testicular mass, urgent referral to a specialist centre is advised 2
- Risk factors for testicular cancer include personal or family history of germ cell tumor, maldescent, orchidopexy, and testicular atrophy 2, 3, 5
Recommendations for Patients with Testicular Microlithiasis
- The presence of testicular microlithiasis alone in the absence of risk factors is not an indication for regular scrotal US, further US screening, or biopsy 2, 3, 4
- Self-examination is the most important factor in the early detection of testicular malignancy 6
- An individualized approach based on the age of the patient, the presence of concurrent features of testicular dysgenesis syndrome, the fertility of the couple, the desire of paternity, and the ultrasound pattern (bilateral and clustered vs. unilateral and limited) is recommended for patients at risk of developing testicular cancer 5
Key Considerations
- The clinical consequences of testicular microlithiasis depend on the co-occurrence of specific risk factors 3
- A link between testicular microlithiasis and testicular cancer, as well as male infertility, has been analyzed 3
- Observation versus testicular biopsy is debatable in patients at risk of developing testicular cancer 5