Diagnosis and Treatment of Early Stage Testicular Cancer: AUA Guideline

Abstract

Purpose: Testis cancer is the most common solid malignancy in young males. The purpose of this guideline is to provide a useful reference on the effective evidence-based treatment of early stage testicular cancer. Methods: The systematic review utilized to inform this guideline was conducted by a methodology team at the Johns Hopkins University Evidence-based Practice Center. The methodology team searched using PubMedÒ, EmbaseÒ, and the Cochrane Central Register of Controlled Trials (CENTRAL) from January 1980 through August 2018. The evidence review team also reviewed relevant systematic reviews and references provided by the panel to identify articles that may have been missed by the database searches. Results: When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low). Such evidence-based statements are provided as Strong, Moderate, or Conditional Recommendations. In instances of insufficient evidence, additional guidance is provided as Clinical Principles and Expert Opinions. Conclusions: This guideline attempts to improve a clinician's ability to evaluate and treat patients with testicular cancer, but higher quality evidence in future trials will be essential to improve level of care for these patients.

<p>Review of Testicular Tumor: Diagnostic Approach and Management Outcome in Africa</p>

“…Testicular cancer is the commonest solid malignancy in young males. 1 Testicular cancer (TC) accounts for 1% of all male cancer and 5% of urological malignancy. 2 According to Albers et al the incidence of testicular cancer varies by ethnicity with higher incidence in high-income nations and lower in low-income countries.…”

“…Evidence has shown that family history of testicular cancer in first degree relative and the presence of contralateral TC/Germ Cell Neoplasia in Situ (GCNIS) may increase the risk of testicular tumors. [1][2][3][4][5][6][7] The predominant histological type is Germ Cell Tumor (90-95%) and 1-2% are found to be bilateral at diagnosis. Germ cell tumor are classified as either Seminoma, non-seminoma, teratoma and mixed tumors with the latter being considered as non-seminomas.…”

“…Germ cell tumor are classified as either Seminoma, non-seminoma, teratoma and mixed tumors with the latter being considered as non-seminomas. 1,3,5,8 This classification was based on biological, histological and practical reasons. The peak incidence for non-seminomatous tumor is in the third decade while pure seminoma peaks in the fourth decade.…”

“…Alpha-Feto Protein (AFP) is produced by both embryonal carcinoma and yolk sac tumors. 1,4 Choriocarcinoma and pure seminoma do not produce AFP; therefore, any pure seminoma with elevated AFP is considered a NSGCT. Beta-Human Chorionic Gonadotropin (Beta-HCG) are produced by both pure seminoma and NSGCT.…”

“…Though LDH is non-specific, it is generally used for prognostic assessment of germ cell tumor at diagnosis and risk stratification of patient with metastatic non-seminomatous germ cell tumor starting chemotherapy. 1,4 The Lactate dehydrogenase-1 (LDH-1) isoenzyme is the most frequently elevated for germ cell testicular tumor. 1 The prognosis of testicular tumor is good with remarkable chemosensitivity to cisplatin-based regimen.…”