New and relevant evidence has been identified, collated, and appraised through a structured assessment of the literature. The search was limited to studies representing high levels of evidence only (i.e., systematic reviews with meta-analysis, randomised controlled trials [RCTs], and prospective non-randomised comparative studies) published in the English language. The search was restricted to articles published between April 2020 and June 2021 and included testicular stromal tumours. Databases covered by the search included PubMed, Ovid, EMBASE and the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. After deduplication, a total of 1,959 unique records were identified, retrieved and screened for relevance. Fifty-eight new and updated references have been included in the 2022 Guidelines. A detailed search strategy is available online: http://uroweb.org/guideline/testicular-cancer/?type=appendices-publications.
For each recommendation within the guidelines there is an accompanying online strength rating form, the basis of which is a modified GRADE methodology [2,3]. Each strength rating form addresses a number of key elements namely:
- the overall quality of the evidence which exists for the recommendation, references used in this text are graded according to a classification system modified from the Oxford Centre for Evidence-Based Medicine Levels of Evidence ;
- the magnitude of the effect (individual or combined effects);
- the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
- the balance between desirable and undesirable outcomes;
- the impact of patient values and preferences on the intervention;
- the certainty of those patient values and preferences.
These key elements are the basis which panels use to define the strength rating of each recommendation. The strength of each recommendation is represented by the words ‘strong’ or ‘weak’ . The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and nature and variability of patient values and preferences.
Additional information can be found in the general Methodology section of this print, and online at the EAU website: www.uroweb.org/guidelines.
A list of associations endorsing the EAU Guidelines can also be viewed online at the above address.
The 2020 Guidelines document was subjected to peer-review following publication.
2.2. Future goals
- A systematic review on diagnostic accuracy on value of the ultrasound (US) in the diagnostic of small testicular masses in collaboration with the Sexual and Reproductive Health has been produced and is under peer-review.
- A review and discussion of the recommendations with patient associations is ongoing.
- The development of a TC survivorship plan in collaboration with patient associations is planned.
- An Individual Patient Data (IPD) prognostic factor study on the value of pathological factors in clinical stage I seminoma testis patients under active surveillance approved by the Guidelines Office Methods Committee and including data from with five international centres is presently in the analysis phase.
- Care Pathways on diagnostic, treatment CS I, and treatment of metastatic disease and Cheat Sheets on TC are being prepared in collaboration with the EAU GO.