The Utilization of Partial Orchiectomy in Treating Small Testicular Tumors in the United States

Introduction and objectives: There is increasing evidence supporting the feasibility of Partial Orchiectomy (PO) as a treatment for small testicular tumors. However, the prevalence of this practice is still unknown. We used the Surveillance, Epidemiology, and End Results (SEER) registry to characterize national practice patterns for surgical management of patients with testicular tumors ≤ 2 cm in size, and we examined factors that determined performing PO in such patients. Materials and methods: 32,211 patients with testicular tumors diagnosed between 1995 and 2011 were extracted for this analysis. The proportions of patients diagnosed with small tumors (≤ 2 cm) and patients treated with PO were determined. Trends were examined using joinpoint analysis and quantified using the Annual Percentage Change (APC). Multivariate survival models were developed to identify independent determinants of PO. Kaplan Meier analysis was used to examine the effect of PO on Cancer Specific Survival (CSS). Results: Of the 5,365 patients with small testicular tumors and identifiable surgical treatment, only 114 patients (2.21%) were treated with PO. The percentage of patients diagnosed with small testicular tumors (on average 18.5% of all testis tumor patients) was stable over the study period (APC -0.47%, 95% CI: -0.3-1.3%, P = 0.2), while the utilization of partial orchiectomy for these tumors remained low and did not increase (APC -11.9%, 95% CI: -16.6 (-6.9)%, P < 0.001). Older age, Black race, and living in areas with lower educational level were independent determinants of lower likelihood of receiving PO (all p values < 0.05). Cancer specific mortality was not worse for patients treated with PO vs. radical orchiectomy (Log-Rank P = 0.8605). Conclusions: While a significant proportion of patients are diagnosed with small testicular tumors, the utilization of PO in treating these patients remains very low. Patient characteristics influenced the chance of treatment with PO. A simple preliminary analysis shows no decrease in CSS with PO vs. RO in patients with testicular masses ≤ 2 cm.