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  • Microlithiasis Followup Study Abstract

    A 5-Year Followup Study of Asymptomatic Men With Testicular Microlithiasis
    Decastro BJ, Peterson AC, Costabile RA
    Department of Urology, Madigan Army Medical Center, Tacoma, Washington.
    University of Virginia School of Medicine, Charlottesville, Virginia.
    J. Urol. 2008, 179, 1420-1423.

    Testicular microlithiasis is an imaging entity of the testicle with questionable significance as a marker for testicular cancer. In 2001 we reported on a large prospective screening study establishing the prevalence of testicular microlithiasis to be 5.6% in a healthy asymptomatic population of Army volunteers 18 to 35 years old. In contrast, testicular cancer develops in only 5 of 100,000 men. Two-year followup of 63 of the 84 patients with testicular microlithiasis showed that none of these men had testicular cancer or scrotal masses. Here we report the 5-year followup in this cohort of men with testicular microlithiasis at risk for testicular cancer.

    According to the original parameters of the screening study we performed a history, genitourinary examination and scrotal ultrasound on 1,504 healthy army volunteers 18 to 35 years old during summer military training. Testicular microlithiasis was defined as greater than 6 echogenic signals found on ultrasound. We identified 84 patients with testicular microlithiasis (5.6%). These men were entered into the followup phase of the study and instructed regarding testicular self-examination and the need for followup. They were told to report any changes in their examination or a finding of testicular mass or cancer. Five years after the initial screening study we attempted to contact all remaining 84 men by e-mail, standard mail and telephone.

    Of the original 84 men with testicular microlithiasis identified in the original screening study, 63 have been contacted via e-mail and by telephone (75%). Of the 63 subjects a mixed germ cell tumor developed in 1 patient 64 months after the initial screening study. Compared to the incidence of testicular cancer in the general population the odds ratio of developing testicular cancer in our study population is 317 (95% CI 36-2,756).

    Testicular cancer will not develop in the majority of men with testicular microlithiasis (98.4%) during a 5-year followup interval. We believe that an intensive screening program for men with testicular microlithiasis is not cost-effective and would do little to improve outcomes associated with testicular cancer. We continue to recommend testicular self-examination in men at risk.
    Last edited by Fed; 03-20-08, 10:05 AM. Reason: Updated Citation (paper has been printed)
    "Statistics are human beings with the tears wiped off" - Paul Brodeur
    Diagnosis: 05Sept07 Right I/O: 13Sept07; Pure Seminoma; Surveillance only per NCCN: All Clear August2013 (CT scan, Markers)

  • #2
    Good find Paul, this seems to answer a critical question regarding microlithiasis.
    Right I/O 4/22/1988
    RPLND 6/20/1988
    Left I/O 9/17/2003

    Tho' much is taken, much abides; and though we are not now that strength which in old days moved earth and heaven; that which we are, we are; one equal temper of heroic hearts, made weak by time and fate, but strong in will; to strive, to seek, to find, and not to yield.


    • #3
      Microlithiasis on the remaining testicle developed after one year

      Dear all,

      Very interesting article, thank you for sharing.

      Last year I got a multi focal seminoma of 6.5cm in my lefty, I was 31.

      My doctor suggested 2 rounds of Carboplatin chemotherapy after the IO and surveillance. Now after a year it seems that the remaining testicle has

      developed a microlithiasis(one spot) and the epididymis seems to be heterogeneous (last year everything was OK). My urologists suggested to

      continue with the yearly US follow up.

      I am really concerned about this do we have any studies regarding microlithiasis for the TC survivors? How many of you have developed

      microlithiasis in the remaining testicle and consequently a malignant mass in it?

      Thank you in advance for your thoughts.

      I wish you the best.


      • #4

        I have had regular USS and self-exam since right microlithiasis discovered 2006.
        Just diagnosed with stage IIIc metastatic seminoma on neck biopsy after imaging for right loin pain found 6cm retroperitoneal nodes.
        Testis felt same throughout and testis ultrasound scan still shows no tumour primary.
        I don't think there is any definite advice one can give for microlithiasis.
        About to start chemo