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EAU Guidelines on Testicular Cancer

Objectives: To establish guidelines for the diagnosis, staging, treatment and follow–up of germ cell testicular cancer. Methods: A search of published work was conducted using Medline. Highly evidence–based articles were selected and their findings analysed by the members of the Oncological Urology Working Group of the EAU. Testis cancer is rare and affects young men in their 3rd and 4th decades of life. The majority of these tumours are derived from germ cells (seminomatous and non–seminoma germ cell testicular cancer), and more than 50% of patients are diagnosed with stage I disease. Epidemiological, pathological and clinical risk factors are well established. The tumour, node, metastasis (TNM) staging system is endorsed, and for metastatic disease a recently devised prognostic–factor–based staging system has proven to be useful. Staging assessment includes pre– and post–orchiectomy marker levels, pathology of the testis, and nodal and visceral status. Following orchiectomy, treatment depends on the tumour type, pathological risk factors for stage I disease and clinical prognostic factors for advanced disease. The cure rate is excellent for disease stages I and II, irrespective of the treatment adopted. However, the pattern of relapse (rate, timing and site) is highly influenced by therapeutic policy. For metastatic disease, survival depends on clinical prognostic factors and treatment. Follow–up schedules are tailored according to stage, tumour type and post–orchiectomy treatment schedules. Conclusions: Excellent cure rates are achieved for early–stage germ cell testis tumours following accurate staging at diagnosis. Satisfactory survival rate can be achieved in advanced metastatic disease using a multidisciplinary therapeutic approach. Follow–up schedules vary, depending on the pathology and stage of the primary tumour and on the treatment policy adopted following orchiectomy.