Testicular Cancer

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

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P. Albers (Chair), W. Albrecht, F. Algaba, C. Bokemeyer, G. Cohn-Cedermark, K. Fizazi, A. Horwich, M.P. Laguna, N. Nicolai, J. Oldenburg
Guidelines Associates: J.L. Boormans,, J. Mayor de Castro


1.1.Aim and objectives

The aim of these guidelines is to present the current evidence for the diagnosis and treatment of patients with cancer of the testis. Testicular cancer represents 5% of urological tumours affecting mostly younger males. This document addresses germ-cell tumours (GCTs) and sex cord/gonadal stromal tumours.

It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2.Panel composition

The European Association of Urology (EAU) Guidelines Panel on Testicular Cancer consists of a multidisciplinary group of clinicians including, urologists, oncologists, radiotherapists and a pathologist. Members of this Panel have been selected, based on their expertise, to represent the professionals treating patients suspected of having testis cancer. All experts involved in the production of this document have submitted potential conflict of interest statements which can be viewed on the EAU website:

1.3.Available publications

A quick reference document (Pocket guidelines) is available, in print and as an app for iOS and Android devices. These are abridged versions which may require consultation together with the full text version. Several scientific publications are available, as are a number of translations of all versions of the EAU Testicular Cancer Guidelines. All documents are accessible through the EAU website: http://www.uroweb.org/guideline/testicular-cancer/.

1.4.Publication history and summary of changes

1.4.1.Publication history

The European Association of Urology (EAU) published the first guidelines on Testicular Cancer in 2001.Since 2008, the Testicular Cancer Guidelines contains a separate chapter on testicular stromal tumours. This document presents a limited update of the 2017 publication. Review papers have been published in the society’s scientific journal European Urology, the latest version dating to 2015 [1].

1.4.2.Summary of changes

For the 2018 Testicular Cancer Guidelines, new references have been added throughout the document. Key changes in this publication include:

  • Section 6.1 – Risk factors for metastatic relapse in clinical stage I was updated by means of a systematic review [2]. Guidelines for the treatment of stage I seminoma


Strength rating

Fully inform the patient about all available management options, including surveillance or adjuvant chemotherapy after orchiectomy, as well as treatment-specific recurrence rates and acute and long-term side effects.

Strong Risk-adapted treatment for clinical stage 1 based on vascular invasion


Strength rating

Stage 1B (pT2-pT4): high risk

Offer primary chemotherapy with one course of BEP, or surveillance.


BEP=bleomycin, etoposide and cisplatin.

7.4.6 Guidelines for the treatment of metastatic germ cell tumours


Strength rating

In metastatic NSGCT with a poor prognosis, treat with one cycle of BEP, or PEI in case of poor lung function, followed by tumour marker assessment after three weeks. In case of a favourable marker decline, continue BEP (or PEI) up to a total of four cycles. In case of an unfavourable decline, initiate chemotherapy intensification.


In CS IIA seminoma, offer radiotherapy or chemotherapy and inform the patient of possible undesirable long-term side effects of both management options.


Initially offer chemotherapy in seminoma stage CS IIB (BEP x 3 or EP x 4, in good prognosis) as an alternative to radiotherapy.


BEP=bleomycin, etoposide and cisplatin; PEI=cisplatin, etoposide and ifosfamide.