Oncological Follow-up Strategies for Testicular Germ Cell Tumours: A Narrative Review

Kaufmann, Ernest; Antonelli, Luca; Albers, Peter; Cary, Clint; Sommer, S.; Heidenreich, Axel; Oing, Christoph; Oldenburg, Jan; Pierorazio, Phillip M.; Stephenson, Andrew J.; Fankhauser, Christian Daniel

doi:10.1016/j.euros.2022.08.014

Cited by 4 publications

(2 citation statements)

References 54 publications

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“…As such, recurrence patterns seen in prospective and retrospective series have been used to generate stage and site-specific follow-up protocols that include computed tomography (CT) scans, chest x-rays, and STM measurements at least more than 5 years after definitive treatment. A recent review compared the guideline follow-up protocols of the ESMO, EAU, the NCCN, and the AUA, as well as selected institutional follow-up protocols like the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) to highlight the discordant recommendations regarding number, time-points, and type of follow-up investigations ( 17 ). These varied recommendations exist largely due to the paucity of data demonstrating a clear best approach.…”

Section: Comment and Evidence Synthesismentioning

confidence: 99%

Novel approaches to redesign surveillance strategies following orchiectomy for localized testicular cancer: a narrative review

Matulewicz¹,

Fankhauser²,

Sheinfeld³

et al. 2023

Transl Androl Urol

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Background and Objective Surveillance is the preferred management strategy for most men with clinical stage I testicular cancer after orchiectomy. However, frequent office visits, imaging tests, and laboratory studies place a significant burden on patients, which may contribute to poor compliance with guideline-recommended surveillance regimens. Identifying strategies to overcome these barriers may help improve quality of life, reduce costs, and improve adherence for patients. We reviewed evidence for three strategies that may help with surveillance redesign: telemedicine, implementing microRNA (miRNA) as a biomarker, and novel imaging protocols. Methods A web-based literature search for novel imaging strategies, diagnostic utility of miRNA, and telehealth as they relate to early-stage testicular germ cell cancer was completed during the month of August 2022. We focused our search on contemporary PubMed-indexed and Google Scholar-registered manuscripts written in English. Supportive data sourced from current guideline statements were also included. Evidence was compiled for narrative review. Key Content and Findings Telemedicine is a safe and acceptable platform for urologic cancer follow-up care, but it requires further study specifically among men with testicular cancer. Access to care may either be improved or reduced depending on system- and patient-level characteristics and should be implemented with this in mind. miRNA may potentially be a helpful biomarker for men with localized disease, but further research on diagnostic accuracy and marker kinetics are needed before implementing it into routine surveillance strategies or using it to deviate from long-standing surveillance regiments. Novel imaging strategies with less frequent imaging and the use of magnetic resonance imaging (MRI) instead of computed tomography (CT) appear to be non-inferior in clinical trials. However, use of MRI requires expert radiologist availability and may be more costly with a lower ability to detect small, early recurrences when used in routine practice. Conclusions Using telemedicine, integrating miRNA as a tumor marker, and adopting less intensive imaging strategies may improve guideline-concordant surveillance for men with localized testicular cancer. Future studies are needed to assess the risks and benefits of using these novel approaches separately or together.

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Section: Comment and Evidence Synthesismentioning

confidence: 99%

Novel approaches to redesign surveillance strategies following orchiectomy for localized testicular cancer: a narrative review

Matulewicz¹,

Fankhauser²,

Sheinfeld³

et al. 2023

Transl Androl Urol

View full text Add to dashboard Cite

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“…The 5-year survival rate of 95% shows that TGCTs are highly curable. If the disease is diagnosed in its early stages, the 5-year survival rate is 99% [13]. Despite the high cure rates overall, in NSE patients with poor prognosis, the 5-year survival rate decreases to 50%.…”

Section: Introductionmentioning

confidence: 99%

Testicular Germ Cell Tumor Tissue Biomarker Analysis: A Comparison of Human Protein Atlas and Individual Testicular Germ Cell Tumor Component Immunohistochemistry

Krasic,

Skara Abramovic,

Himelreich Peric

et al. 2023

Cells

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The accurate management of testicular germ cell tumors (TGCTs) depends on identifying the individual histological tumor components. Currently available data on protein expression in TGCTs are limited. The human protein atlas (HPA) is a comprehensive resource presenting the expression and localization of proteins across tissue types and diseases. In this study, we have compared the data from the HPA with our in-house immunohistochemistry on core TGCT diagnostic genes to test reliability and potential biomarker genes. We have compared the protein expression of 15 genes in TGCT patients and non-neoplastic testicles with the data from the HPA. Protein expression was converted into diagnostic positivity. Our study discovered discrepancies in three of the six core TGCT diagnostic genes, POU5F1, KIT and SOX17 in HPA. DPPA3, CALCA and TDGF1 were presented as potential novel TGCT biomarkers. MGMT was confirmed while RASSF1 and PRSS21 were identified as biomarkers of healthy testicular tissue. Finally, SALL4, SOX17, RASSF1 and PRSS21 dysregulation in the surrounding testicular tissue with complete preserved spermatogenesis of TGCT patients was detected, a potential early sign of neoplastic transformation. We highlight the importance of a multidisciplinary collaborative approach to fully understand the protein landscape of human testis and its pathologies.

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SEOM-GG clinical guidelines for the management of germ-cell testicular cancer (2023)

Arranz Arija,

del Muro,

Caro

et al. 2024

Clin Transl Oncol

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Testicular germ cell tumors are the most common tumors in adolescent and young men. They are curable malignancies that should be treated with curative intent, minimizing acute and long-term side effects. Inguinal orchiectomy is the main diagnostic procedure, and is also curative for most localized tumors, while patients with unfavorable risk factors for recurrence, or those who are unable or unwilling to undergo close follow-up, may require adjuvant treatment. Patients with persistent markers after orchiectomy or advanced disease at diagnosis should be staged and classified according to the IGCCCG prognostic classification. BEP is the most recommended chemotherapy, but other schedules such as EP or VIP may be used to avoid bleomycin in some patients. Efforts should be made to avoid unnecessary delays and dose reductions wherever possible. Insufficient marker decline after each cycle is associated with poor prognosis. Management of residual masses after chemotherapy differs between patients with seminoma and non-seminoma tumors. Patients at high risk of relapse, those with refractory tumors, or those who relapse after chemotherapy should be managed by multidisciplinary teams in experienced centers. Salvage treatment for these patients includes conventional-dose chemotherapy (TIP) and/or high-dose chemotherapy, although the best regimen and strategy for each subgroup of patients is not yet well established. In late recurrences, early complete surgical resection should be performed when feasible. Given the high cure rate of TGCT, oncologists should work with patients to prevent and identify potential long-term side effects of the treatment. The above recommendations also apply to extragonadal retroperitoneal and mediastinal tumors.

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Oncological Follow-up Strategies for Testicular Germ Cell Tumours: A Narrative Review

Cited by 4 publications

References 54 publications

Novel approaches to redesign surveillance strategies following orchiectomy for localized testicular cancer: a narrative review

Novel approaches to redesign surveillance strategies following orchiectomy for localized testicular cancer: a narrative review

Testicular Germ Cell Tumor Tissue Biomarker Analysis: A Comparison of Human Protein Atlas and Individual Testicular Germ Cell Tumor Component Immunohistochemistry

SEOM-GG clinical guidelines for the management of germ-cell testicular cancer (2023)

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