Testicular germ-cell tumors represent the most common solid neoplasms among young men aged 20-40 yr. Owing to interdisciplinary management and high chemosensitivity, cure rates are high even among patients with poor risk. Although the diagnostic and therapeutic approaches for organ-confined disease and low-volume and high-volume metastatic disease are well standardized and reported in numerous national and international guidelines, guidelines, high frequency of guideline noncompliance has recently been observed, resulting in poorer long-term outcomes. This article underlines the clinically most important messages that should be adhered to in the management of testis cancer patients to avoid patient harm and achieve the best therapeutic outcomes. These recommendations include: (1) a detailed pathology report by an experienced uropathologist; (2) organ-sparing surgery or frozen section analysis for patients with bilateral testis cancer or testicular masses of uncertain identity; (3) risk-adapted therapy for clinical stage I seminomas and nonseminomas; and (4) interdisciplinary management of patients with advanced testis cancer in high-volume centers. PATIENT SUMMARY: Management of testis cancer has been standardized but lack of compliance with guidelines is increasing, resulting in inferior oncological outcomes. Close adherence to guidelines and early referral of complex cases are of utmost importance for high cure rates.
European urology focus. 2019 Aug 16 [Epub]
Axel Heidenreich, Pia Paffenholz, Tim Nestler, David Pfister
Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany. Electronic address: ., Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany.