Testicular Cancer

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

ISBN 978-94-92671-07-3

M.P. Laguna (Chair), P. Albers, F. Algaba, C. Bokemeyer, J.L. Boormans, S. Fischer, K. Fizazi, H. Gremmels (Patient advocate), R. Leão, D. Nicol, N. Nicolai, J. Oldenburg, T. Tandstad
Guidelines Associates: J. Mayor de Castro, C.D. Fankhauser, F. Janisch, , T. Muilwijk
Consultant radiologist: Y. Jain

1.INTRODUCTION

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 (TC) 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 which should also take 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 EAU Guidelines Panel on Testicular Cancer consists of a multidisciplinary group of clinicians including, urologists, oncologists, a radio-oncologist and a pathologist. Members of this Panel have been selected, based on their expertise, to represent the professionals treating patients suspected of having TC. All experts involved in the production of this document have submitted potential conflict of interest statements which can be viewed on the EAU website: http://www.uroweb.org/guideline/testicular-cancer/.

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/testicularcancer/.

1.4.Publication history and summary of changes

1.4.1.Publication history

The European Association of Urology (EAU) published the first guidelines on TC in 2001. Since 2008, the Testicular Cancer Guidelines contains a separate chapter on testicular stromal tumours. This document presents a limited update of the 2019 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 2020 Testicular Cancer Guidelines, new references have been added throughout the document. Key changes in this publication include:

  • A table on minimal sets for pathology reports of neoplasia of the testis has been included in the 2020 version.
  • Citations relating to a number of low quality papers (SEER database on epidemiology retrospective biased fluorodeoxyglucose-positron emission tomography [FDG-PET] scan and non-validated prognostic models) have been removed from the text. As per previous versions of the text, some small phase II studies in the relevant text section on second relapse are included since there are few publications addressing this rare and desperate clinical scenario.
  • Several old citations have been replaced with newer reports.
  • Beyond the Scope search, a few relevant articles identified in the months after the search have been included.
  • Text and tables throughout the guideline have been rephrased and revised.
  • The panel is aware that a new International Germ Cell Cancer Collaborative Group (IGCCCG) classification for metastatic tumours has recently been presented. This new classification stratifies more accurately the population of patients with metastatic TC than the one proposed in 1997 and used in these guidelines. However, as of December 2019, there is no “peer reviewed” publication or external validation of the proposed new classification. Once published, these will be incorporated into the 2021 version of the guideline.
  • Recommendations on abdominal, thorax and brain imaging at diagnostic and staging have been reviewed by a consultant radiologist.
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