Assessing the size and stage of testicular germ cell tumours: 1984-2003

OBJECTIVE To assess the size and stage of testicular tumours on presentation in the period 1984-2002. PATIENTS AND METHODS Demographic details and information on staging on 550 patients treated at St. Bartholomew's and the Royal London Hospital in the period 1984-2002 were collected prospectively in the departmental database. Information on testicular size was obtained by reviewing the histopathology records, and the maximum dimension of the tumour as measured in the gross specimen was taken as the size of the testicular tumour. RESULTS The period 1984-2002 was divided into three intervals, i.e. 1984-95, 1996-98 and 1999-2002. The mean testicular tumour size in the three intervals decreased from 4 cm (162 tumours) to 3.2 cm (85) and 2.5 cm (72; P= 0.002, Student's t-test). The proportion of tumours of <2 cm on presentation also increased, from 11% to 14% and 23% in the three intervals, respectively, while the proportion of patients with stage 1 disease increased from 57%, to 63% and 77%, respectively. CONCLUSIONS The size of testicular tumours on presentation has shown a consistent decline in the last two decades, the mean size now being 2.5 cm. That 23% are now <2 cm raises the possibility of testis-preserving surgery in this young group of patients, who have an excellent prognosis, and therefore in the long-term issues such as psychological morbidity and natural fertility assume greater importance. There is a need for a randomized controlled trial to evaluate these issues.