Testicular Microlithiasis: Can It Cause Cancer?

Testicular microlithiasis is usually diagnosed during ultrasound scan done as screening or for suspected testicular mass. Those many white dots which appear in the ultrasound image are calcium deposits. However, it has no relation with how much calcium you eat. Should a man worry if he is told to have testicular microlithiasis?

Unfortunately, though testicular microlithiasis is widely recognized and diagnosed, we still do not understand it well. The cause of it is still unknown, and its consequences are still very much debatable. The most worrying issue regarding testicular microlithiasis is its association with a type of testicular cancer called testicular germ cell tumour. 

     Microlithiasis: The "Stars" are the microliths

Opinion regarding the link between testicular microlithiasis and cancer varies between different countries and even between different doctors within the same country. However, if you have testicular microlithiasis, definitely you need to have it monitored regularly and should not just leave it alone.

For people with testicular microlithiasis, it is easier to divide them into 3 groups. How they should be followed up with their doctor depends on which group they are in.

• Testicular microlithiasis and asymptomatic (no symptoms and healthy)
• Testicular microlithiasis with symptoms of testicular dysgenesis syndrome
• subfertility (difficult to get baby)
• cryptorchidism (undescended testis)
• testicular atrophy (reduction in testis size)
• gonadal dysgenesis (abnormality in sexual organs development)
• Testicular microlithiasis with  concurrent germ cell tumour

For those who are asymptomatic and apparently healthy, you need to see a doctor to rule out the presence of testicular dysgenesis syndrome. If everything is fine, the risk of developing testicular germ cell tumour is not high. However, it is advisable to perform testicular self-examination regularly and see your doctor/urologist for examination or ultrasound scan annually. Biopsy is usually not required.

For those who have testicular dysgenesis syndrome, the risk of testicular germ cell tumour is said to be higher than others who do not have the symtoms. A condition called intratubular germ cell neoplasia with unclassified type (or testicular carcinoma in-situ), which is "pre-cancerous" condition , can be found in 11-18% of those with both testicular microlithiasis and testicular dysgenesis syndrome. In such case, you need to consult a urologist to discuss whether a testicular biopsy and further imaging studies are necessary. Monitoring of tumour markers such as AFP and hCG may be helpful.

For those who has concurrent unilateral (one-sided) germ cell tumour, the presence of microlithiasis may suggest that the risk of cancer in the other testis is higher. Thus, further management such as chemotherapy may differ.

It is wrong to say that testicular microlithiasis can cause cancer. However, it is related to testicular cancer. Having testicular microlithiasis does not mean that one will definitely develop testicular cancer in the future. As testicular microlithiasis is still considered inadequately studied, please liaise with your urologist as he/she will know the latest development regarding this condition.