Should ultrasound surveillance be recommended for patients with testicular microlithiasis?

In the past, researchers have recommended ultrasound surveillance of patients with testicular microlithiasis (TM) due to a stated association between TM and testicular cancer (TC). However, according to a recent analysis published by the American Journal of Roentgenology, more recent recommendations do not support such surveillance when no other risk factors (family history, infertility, and so on) are prevalent.

Thomas C. Winter, MD, University of Utah Medical Center in Salt Lake City, Utah, and colleagues examined the long history of medical research about TM.

They noted studies from 1994 and 2001, for instance, that found a significant association with testicular cancer among patients with TM. And as the number of such studies increased, Winter et al. explained, “an association of TC with TM was strongly suggested.”

“The recommendations that emerged from many of these studies included very strongly worded implications regarding costly follow-up examinations, including biopsy, CT, analysis of serum tumor markers, and ultrasound and physical examinations, with morbidity potentially associated with the use of such follow-up methods,” the authors wrote.

Thinking has “evolved” in more recent years, however. Researchers began to question this association between TM and TC. The authors list numerous examples of this trend, including a study published in The Journal of Urology by Andrew C. Peterson, MD, and colleagues in 2001.

“Current recommendations to perform aggressive screening in patients with testicular microlithiasis appear to be based largely on anecdotal associations,” Peterson et al. wrote at the time, adding TC can be diagnosed “easily with minimal cost by testicular self-examination or clinical examination with a current cure rate approaching 100 percent.”

“Other researchers soon began to echo a similar sentiment,” Winter and colleagues wrote.

So what should healthcare providers recommend? The authors concluded by providing their own recommendation for a possible dictation template in cases when TM is present with no other risk factors.

“In the absence of any other risk factors for testicular cancer (e.g., personal history of testicular cancer, a father or brother with testicular cancer, history of cryptorchidism or maldescent, testicular atrophy, or other risk factors), no further imaging or biochemical follow-up is necessary; all that is recommended is routine monthly testicular self-examination,” the authors wrote. “However, if the patient has risk factors for testicular cancer, referral to a urologist for evaluation and determination of an optimal follow-up strategy is recommended.”