The impact of age at orchiopexy on testicular cancer outcomes

Abstract

Purpose

To estimate how many boys with UDT must undergo orchiopexy to prevent one case of TC, one death from TC and one exposure to TC treatment beyond radical orchiectomy as compared to being treated at an older age.

Methods

This retrospective study utilized data from a 2007 Swedish study of males who underwent orchiopexy for UDT (Pettersson et al.). TC incidence for boys undergoing orchiopexy for UDT was assessed based on the age at orchiopexy (0–6 years, 7–9 years, 10–12 years, 13–15 years). The incidence of TC in each age cohort was calculated and used to determine the number needed to treat (NNT) for each age group using assumptions based on published TC outcomes.

Results

For an index patient ≤ 6 years, 372 boys need to undergo orchiopexy to prevent a single case of TC, 1488 boys to prevent exposure to TC therapy beyond radical orchiectomy, and 5315 boys to prevent a single TC-related death compared to treatment at an older age.

Conclusion

While there is evidence supporting benefits of early orchiopexy, the NNT to affect TC outcomes is very high. Even those with delayed orchiopexies have low risk for TC poor outcomes. This information can be used when counseling patients and families faced with UDT about the risks related to TC, especially with comorbidities.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Abbreviations

NNT:

Number needed to treat

TC:

Testicular cancer

UDT:

Undescended testicle(s)

References

  1. 1.

    Toppari J, Kaleva M (1999) Maldescendus testis. Horm Res 51:261

    CAS  PubMed  Google Scholar 

  2. 2.

    Berkowitz GS, Lapinski RH, Dolgin SE et al (1993) Prevalence and natural history of cryptorchidism. Pediatrics 92:44

    CAS  PubMed  Google Scholar 

  3. 3.

    Cortes D, Thorup JM, Visfeldt J (2001) Cryptorchidism: aspects of fertility and neoplasms. A study including data of 1335 consecutive boys who underwent testicular biopsy simultaneously with surgery for cryptorchidism. Horm Res 55:21

    CAS  PubMed  Google Scholar 

  4. 4.

    Husmann DA (2005) Cryptorchidism and its relationship to testicular neoplasia and microlithiasis. Urology 66:424

    CAS  Article  Google Scholar 

  5. 5.

    Wood HM, Elder JS (2009) Cryptorchidism and testicular cancer: separating fact from fiction. J Urol 181:452

    Article  Google Scholar 

  6. 6.

    Stokes W, Amini A, Maroni PD et al (2017) Patterns of care and survival outcomes for adolescent and young adult patients with testicular seminoma in the United States: a national cancer database analysis. J Pediatr Urol 13:386.e1

    Article  Google Scholar 

  7. 7.

    Saltzman AF, Cost NG (2018) Adolescent and young adult testicular germ cell tumors: special considerations. Adv Urol 2018:2375176

    Article  Google Scholar 

  8. 8.

    Nichols CR, Roth B, Albers P et al (2013) Active surveillance is the preferred approach to clinical stage I testicular cancer. J Clin Oncol 31:3490

    Article  Google Scholar 

  9. 9.

    Pettersson A, Richiardi L, Nordenskjold A et al (2007) Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med 356:1835

    CAS  Article  Google Scholar 

  10. 10.

    Kolon TF, Herndon A, Baker LA et al. (2014) Evaluation and treatment of cryptorchidism. American Urological Association 2014. https://www.auanet.org/guidelines/cryptorchidism-(2014)#x2573. Accessed 20 June 2018

  11. 11.

    Radmayr C (2017) Management of undescended testes: European Association of Urology/European Society for Paediatric Urology guidelines. J Pediatr Urol 13:550

    Article  Google Scholar 

  12. 12.

    Altman DG (1998) Confidence intervals for the number needed to treat. BMJ 317:1309

    CAS  Article  Google Scholar 

  13. 13.

    Sui W, Morrow DC, Bermejo CE et al (2015) Trends in testicular cancer survival: a large population-based analysis. Urology 85:1394

    Article  Google Scholar 

  14. 14.

    AMerican Cancer Society (2019) Cancer facts and figures 2019. American Cancer Society, Atlanta

    Google Scholar 

  15. 15.

    Gleason JM, Bowlin PR, Bagli DJ et al (2015) A comprehensive review of pediatric urachal anomalies and predictive analysis for adult urachal adenocarcinoma. J Urol 193:632

    Article  Google Scholar 

  16. 16.

    Hanna NH, Einhorn LH (2014) Testicular cancer—discoveries and updates. N Engl J Med 371:2005

    Article  Google Scholar 

  17. 17.

    Fossa SD, Oldenburg J, Dahl AA (2009) Short- and long-term morbidity after treatment for testicular cancer. BJU Int 104:1418

    Article  Google Scholar 

  18. 18.

    Travis LB, Fossa SD, Schonfeld SJ et al (2005) Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst 97:1354

    Article  Google Scholar 

  19. 19.

    Chien FL, Schwartz SM, Johnson RH (2014) Increase in testicular germ cell tumor incidence among Hispanic adolescents and young adults in the United States. Cancer 120:2728

    Article  Google Scholar 

  20. 20.

    DeRouen MC, Mujahid M, Srinivas S et al (2016) Disparities in adolescent and young adult survival after testicular cancer vary by histologic subtype: a population-based study in California 1988–2010. J Adolesc Young Adult Oncol 5:31

    Article  Google Scholar 

  21. 21.

    Tasian GE, Hittelman AB, Kim GE et al (2009) Age at orchiopexy and testis palpability predict germ and Leydig cell loss: clinical predictors of adverse histological features of cryptorchidism. J Urol 182:704

    Article  Google Scholar 

Download references

Funding

The study was funded by Etkin Family Fund of the Aspen Community Foundation.

Author information

Affiliations

Authors

Contributions

MH: data analysis and manuscript writing/editing. DES: protocol/project development, data collection or management, and data analysis. DG protocol/project development, data collection or management, and data analysis. DW protocol/project development, and manuscript writing/editing. NGC protocol/project development, data collection or management, data analysis, and manuscript writing/editing. AFS protocol/project development, data collection or management, data analysis, and manuscript writing/editing.

Corresponding author

Correspondence to Amanda F. Saltzman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest statement.

Ethical approval

IRB approval was not obtained for this study as it is a secondary analysis of published work.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Higgins, M., Smith, D.E., Gao, D. et al. The impact of age at orchiopexy on testicular cancer outcomes. World J Urol 38, 2531–2536 (2020). https://doi.org/10.1007/s00345-019-03034-9

Download citation

Keywords

  • Testicular cancer
  • Undescended testicle
  • Orchiopexy
  • Number needed to treat