1.4.2 Summary of changes
For the 2020 Testicular Cancer Guidelines, new references have been added throughout the document. Key changes in this publication include:
- A table on minimal sets for pathology reports of neoplasia of the testis has been included in the 2020 version.
- Citations relating to a number of low quality papers (SEER database on epidemiology retrospective biased fluorodeoxyglucose-positron emission tomography [FDG-PET] scan and non-validated prognostic models) have been removed from the text. As per previous versions of the text, some small phase II studies in the relevant text section on second relapse are included since there are few publications addressing this rare and desperate clinical scenario.
- Several old citations have been replaced with newer reports.
- Beyond the Scope search, a few relevant articles identified in the months after the search have been included.
- Text and tables throughout the guideline have been rephrased and revised.
- The panel is aware that a new International Germ Cell Cancer Collaborative Group (IGCCCG)
classification for metastatic tumours has recently been presented. This new classification stratifies more accurately the population of patients with metastatic TC than the one proposed in 1997 and used in these guidelines. However, as of December 2019, there is no “peer reviewed” publication or external validation of the proposed new classification. Once published, these will be incorporated into the 2021 version of the guideline.
- Recommendations on abdominal, thorax and brain imaging at diagnostic and staging have been reviewed by a consultant radiologist.
5.8 Guidelines for the diagnosis and staging of testicular cancer
| Recommendations | Strength rating |
| Perform physical examination including supraclavicular, cervical, axillary and inguinal lymph nodes, breast and testicles. | Strong |
| Measure serum tumour markers both before and after orchiectomy taking into account half-life kinetics. | Strong |
| Perform contrast enhanced computerised tomography (CT) scan (chest, abdomen and pelvis) in patients with a diagnosis of TC. If iodine allergy or other limiting factors perform abdominal and pelvic magnetic resonance imaging (MRI). | Strong |
| Perform MRI of the brain (or brain CT if not available) in patients with multiple lung metastases, or high beta subunit of human Chorionic Gonadotropin (β-Hcg) values, or those in the poor-prognosis International Germ Cell Cancer Collaborative Group (IGCCCG) risk group. | Strong |
| Perform MRI of the brain (or brain CT if not available) in patients with multiple lung metastases, or high beta subunit of human Chorionic Gonadotropin (β-Hcg) values, or those in the poor-prognosis International Germ Cell Cancer Collaborative Group (IGCCCG) risk group. | Strong |
| Do not use positron emission tomography–computed tomography or bone scan for staging. | Strong |
| Discuss testis-sparing surgery with frozen section examination in patients with a high-likelihood of having a benign testicular tumour which are suitable for enucleation. | Strong |
| Offer biopsy of the contralateral testis to patients with TC and at high-risk for contralateral germ cell neoplasia in situ. | Strong |
7.1.2.5 Guidelines for the treatment of stage I seminoma
| Recommendations | Strength rating |
| Fully inform the patient about all available management options, including surveillance or adjuvant therapy after orchidectomy, as well as treatment-specific recurrence rates and acute and long-term side effects. | Strong |
| Do not routinely perform adjuvant radiotherapy. This option should be reserved for selected patients not suitable for surveillance and with contraindications to chemotherapy. | Strong |
7.1.3.7 Risk-adapted treatment for clinical stage 1 non-seminomatous germ cell tumour based on vascular Invasion
| Recommendations | Strength rating |
| Stage IB (pT2-pT4): high risk | |
| Offer primary chemotherapy with one course of BEP, or surveillance and discuss the advantages and disadvantages. | Strong |
| Offer nerve-sparing retroperitoneal lymph node dissection (RPLND) to highly selected patients only; those with contraindication to adjuvant chemotherapy and unwilling to accept surveillance. | Strong |
| Primary RPLND should be advised in men with teratoma with somatic-type malignancy. | Strong |