European Association of Urology Guidelines on Testis Cancer: Important Take Home Messages

Heidenreich, Axel; Paffenholz, Pia; Nestler, Tim; Pfister, D.

doi:10.1016/j.euf.2019.08.002

Cited by 24 publications

(31 citation statements)

References 23 publications

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“…Since the introduction of platinum‐based chemotherapy in 1970s, the survival of testicular cancer has significantly increased, with even the poorest prognosis group patients reaching a 5‐year survival of approximately 48% . Even in an optimal treatment scenario, the burden of disease is further increased by undesirable effects of treatment related to the absence of one or both testicles, including subfertility, hypogonadism, sexual dysfunction, metabolic syndrome and osteoporosis, as well as secondary cancers, cardiovascular disease, peripheral neuropathy, ototoxicity and hepatotoxicity in patients treated by radiotherapy and chemotherapy, providing an additional incentive to prioritise early diagnosis …”

Section: Discussionmentioning

confidence: 99%

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Testicular cancer incidence predictions in Europe 2010–2035: A rising burden despite population ageing

Znaor

Skakkebæk

Meyts

et al. 2019

Intl Journal of Cancer

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Testicular cancer is the most common cancer among young men of European ancestry, with about one-third of all cases occurring in Europe. With the historically increasing trends in some high-incidence populations reported to have stabilised in recent years, we aimed to assess recent trends and predict the future testicular cancer incidence burden across Europe. We extracted testicular cancer (ICD-10 C62) incidence data from Cancer Incidence in Five Continents Volumes VII-XI and complemented this with data published by registries from 28 European countries. We predicted cancer incidence rates and the number of incident cases in Europe in the year 2035 using the NORDPRED age-period-cohort model. Testicular cancer incidence rates will increase in 21 out of 28 countries over the period 2010-2035, with trends attenuating in the high-incidence populations of Denmark, Norway, Switzerland and Austria. Although population ageing would be expected to reduce the number of cases, this demographic effect is outweighed by increasing risk, leading to an overall increase in the number of cases by 2035 in Europe, and by region (21, 13 and 32% in Northern, Western and Eastern Europe, respectively). Declines are however predicted in Italy and Spain, amounting to 12% less cases in 2035 in Southern Europe overall. In conclusion, the burden of testicular cancer incidence in Europe will continue to increase, particularly in historically lower-risk countries. The largest increase in the number of testicular cancer patients is predicted in Eastern Europe, where survival is lower, reinforcing the need to ensure the provision of effective treatment across Europe.Additional Supporting Information may be found in the online version of this article.

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Section: Discussionmentioning

confidence: 99%

“…Adherence to treatment guidelines presents an important aspect to achieve and maintain excellent treatment results and to reduce long‐term toxicity . Current guidelines from the European Association of Urology support a uniformity of effective treatment pathways across European countries, at least for the lower stage tumours.…”

Section: Discussionmentioning

confidence: 99%

Testicular cancer incidence predictions in Europe 2010–2035: A rising burden despite population ageing

Znaor

Skakkebæk

Meyts

et al. 2019

Intl Journal of Cancer

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“…Testicular germ cell tumours are the most common solid neoplasms in young men with an incidence of up to 10 in 100 000 [ 1 ]. The traditionally accepted management for testicular tumours is radical orchidectomy, whilst testicular-sparing surgery (TSS) is considered for specific indications such as bilateral tumours, monorchid patients, or in children where the likelihood of benign pathology is high [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

The role of radiological surveillance in the conservative management of incidental small testicular masses: A systematic review

Brown

Tsampoukas

Popov³

et al. 2021

Arab Journal of Urology

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Objective: The increasing use of scrotal ultrasonography (US) for non-cancerous indications has led to greater detection of incidental, small testicular masses. Operative intervention is currently the mainstay of treatment for all testicular tumours; however, despite the low malignant potential of small, incidental masses, little is known about conservative management using radiological surveillance. Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted and studies meeting the inclusion criteria were reviewed for patient outcomes. Results: A total of 293 patients across six studies underwent radiological surveillance for an incidental small testicular mass. Infertility was the main indication for investigation and all studies used US as the surveillance modality. A total of 37 patients (12.6%) underwent surgical exploration during follow-up, with only 10 (3.4%) found to have malignant disease at histology. Conclusions: Radiological surveillance of incidental small testicular masses is safe when used for select patient groups due to the high probability of benign disease, although optimal patient selection criteria and a well-defined protocol are lacking. This approach could be considered in patients with incidental, impalpable testicular masses of ≤5 mm in diameter displaying no significant size increase or internal vascularity on US and with negative tumour markers, as the probability of malignancy in these patients is low.

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“…Instead, biopsies of testicular or paratesticular lesions are occasionally submitted for intraoperative FSA to determine if organ‐sparing surgery is an optimal option. Indeed, FSA is highly recommended prior to proceeding with radical orchiectomy in patients with a mass of uncertain identity 67 . FSA may also play a critical role in ensuring complete resection of the lesions during partial orchiectomy which has been adopted for the treatment of testicular malignant disease in select patients 67,68 .…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, FSA is highly recommended prior to proceeding with radical orchiectomy in patients with a mass of uncertain identity 67 . FSA may also play a critical role in ensuring complete resection of the lesions during partial orchiectomy which has been adopted for the treatment of testicular malignant disease in select patients 67,68 . Meanwhile, FSA has been found to be highly accurate for distinguishing between benign and malignant testicular tumors, leading to high sensitivity (95%–100%) and specificity (86%–100%) across all the studies included in a meta‐analysis 69 .…”

Section: Introductionmentioning

confidence: 99%

Intraoperative pathology consultation during urological surgery: Impact on final margin status and pitfalls of frozen section diagnosis

Miyamoto

2021

Pathology International

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Despite recent improvements in diagnostic and surgical techniques in urological oncology, positive resection margin remains a significant concern for surgeons. Meanwhile, intraoperative pathology consultation with frozen section assessment (FSA), particularly for histological diagnosis of the lesions incidentally found or enlarged or sentinel lymph nodes, generally provides critical information which enables immediate decision making for optimal patient care. The intraoperative evaluation of surgical margins is also often requested, although there are some differences in its application between institutions and surgeons. Importantly, it remains to be determined whether intraoperative FSA indeed contributes to reducing the risk of final positive margins and thereby improving long‐term patient outcomes. This review summarizes available data indicating the potential impact of FSA at the surgical margins during urological surgeries, including radical or partial cystectomy, partial nephrectomy, radical prostatectomy, penectomy, and orchiectomy. The accuracy and pitfalls of the intraoperative consultation/FSA diagnosis are also discussed.

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European Association of Urology Guidelines on Testis Cancer: Important Take Home Messages

Cited by 24 publications

References 23 publications

Testicular cancer incidence predictions in Europe 2010–2035: A rising burden despite population ageing

Testicular cancer incidence predictions in Europe 2010–2035: A rising burden despite population ageing

The role of radiological surveillance in the conservative management of incidental small testicular masses: A systematic review

Intraoperative pathology consultation during urological surgery: Impact on final margin status and pitfalls of frozen section diagnosis

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