Guidelines

Testicular Cancer

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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 post-pubertal testicular germ-cell tumours (TGCTs) in the male including spermatocytic tumour 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 references/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 European Association of Urology (EAU) Guidelines Panel on TC consists of a multidisciplinary group of clinicians including, urologists, medical oncologists, a radiation-oncologist, and a pathologist. When necessary, consultants from other specialties provide input. Members of this Panel have been selected, based on their expertise, to represent the professionals’ treating patients with 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 on the EAU website. 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 TC 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 EAU published the first guidelines on TC in 2001. Since 2008, the TC Guidelines contains a separate chapter on testicular stromal tumours. The 2023 TC guideline presents a limited update of the 2022 publication with a full update scheduled for the 2024 print. A summary paper of the EAU TC guideline has 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 2023 Testicular Cancer Guidelines, the key changes incorporated in this publication include:

  • A forensic review of all the recommendations and supporting text;
  • Old citations have been refreshed and replaced with newer references;
  • The recent re-validation of the 1997 International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic risk-factor based system for metastatic testicular Germ cell tumours in patients treated with cisplatin-etoposide as first-line chemotherapy has been included in the text replacing the old version with the corresponding references;
  • New supporting text regarding VTE prophylaxis in males with metastatic germ cell tumours (GCTs) receiving chemotherapy has been added;
  • Update of the histological classifications in sections 3.2 as well as inclusion of the World Health Organization (WHO) 2022 pathological classification.