The 2021 updated International Germ Cell Cancer Collaborative Group classification for seminomatous germ cell tumours confirmed and refined the original classification, introducing the notion that lactate dehydrogenase (LDH) elevation above 2. 5 times the upper limit of normal separates the good-risk prognostic group into two distinct subgroups, with clearly inferior survival outcomes for the high-LDH subgroup. Validation of this prognostic factor has understandably opened the question of the optimal management for patients with high-LDH good-risk seminoma. In the absence of prospective evidence, guideline-recommended management options have not changed. However, there is evidence from the testicular cancer community that management trends might have been influenced by the poor prognosis associated with elevated LDH. The Testicular Cancer Guidelines Panel of the European Association of Urology has undertaken a global survey among oncologists and onco-urologists to document management trends and differences. PATIENT SUMMARY: Levels of an enzyme called LDH (lactate dehydrogenase) can differ among patients with testicular cancer that has good prognosis. Recent evidence shows worse outcomes for patients with higher LDH. This information should be used to update clinical guidelines and to tailor personalised treatment plans for these patients.
European urology oncology. 2025 Feb 05 [Epub ahead of print]
Anna Patrikidou, Christoph Oing, Christos Markellos, Axel Heidenreich, Ricardo Leao, Nicola Nicolai, Joost Boormans, Stefanie Fischer, Christian Fankhauser, Walter Cazzaniga, Patrizia Giannatempo, Daniel Berney, Hendrik Gremmels, Robert Cornes, Florian Janisch, Domenico Di Nardo, Alexandros Papachristofilou, Karim Fizazi, Togrim Tandstad, David Nicol, Robert Huddart, European Association of Urology Testicular Cancer Guidelines Panel
Genitourinary Oncology Team Department of Cancer Medicine Gustave Roussy Cancer Campus Villejuif France; Early Drug Development Department Gustave Roussy Cancer Campus Villejuif France. Electronic address: ., Translational and Clinical Research Institute Newcastle University Centre for Cancer and Northern Centre for Cancer Care Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK., Early Drug Development Department Gustave Roussy Cancer Campus Villejuif France., Department of Urology Uro-Oncology Robot-Assisted and Specialized Urologic Surgery University Hospital Cologne Cologne Germany., Faculty of Medicine University of Coimbra Cuf Hospitais Coimbra Portugal., Urology Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy., Department of Urology Erasmus MC Cancer Institute Rotterdam The Netherlands., Klinik für Medizinische Onkologie und Hämatologie Kantonsspital St. Gallen St. Gallen Switzerland., Urology Department Luzerner Kantonsspital Sursee Switzerland., Department of Urology Royal Marsden NHS Foundation Trust Sutton UK., Department of Cellular Pathology Queen Mary University of London London UK., Department of Nephrology University Medical Center Utrecht Utrecht The Netherlands., Orchid Male Cancer London UK., Department of Urology University Medical Center Hamburg-Eppendorf Hamburg Germany., Department of Oncology Azienda Ospedaliera Universitaria Federico II Napoli Italy., Department of Radiation Oncology University Hospital Basel Basel Switzerland., Genitourinary Oncology Team Department of Cancer Medicine Gustave Roussy Cancer Campus Villejuif France., Medical Oncology Department St. Olav's Hospital Cancer Clinic Trondheim Norway., Academic Urology Unit Institute of Cancer Research and Royal Marsden NHS Foundation Trust Sutton UK.