Canadian Urological Association consensus guideline: Management of testicular germ cell cancer

Abstract

At the Canadian GCT meeting held in Toronto in 2018, Canadian GCT providers prioritized updating the Canadian consensus document, which was last updated in 2010. 7 MethodsA multidisciplinary group of Canadian testicular cancer experts (nine medical oncologists, five uro-oncologists, two radiation oncologists, one genitourinary pathologist, and one genitourinary radiologist) participated in updating this guideline. Participants were assigned stage-specific topics to update and the project leads (RH, CC, LW) participated in updating all topics. Five individual stage-specific meetings with each subgroup of experts were conducted in April 2021 to discuss and develop key recommendations. Once recommendations were compiled, all participants voted via SurveyMonkey to determine their level of agreement. Modifying methods used by the European Association of Urology and European Society for Medical Oncology Guidelines Committees, each recommendation was followed by a five-point Likert scale: completely disagree, somewhat disagree, undecided, somewhat agree, completely agree, abstain (out of scope of my practice and/or I don't feel comfortable answering). 8 A priori, agreement was defined as ≥75% of experts voting somewhat agree or completely agree. Results from this initial vote are shown in Supplementary Figure 1 (available at cuaj.ca).In June 2021, a full group virtual meeting was held to discuss one recommendation that did not reach agreement, along with 22 other recommendations that, despite ≥75% agreement, some experts had indicated disagreement or undecided opinions. Proposed changes were made accordingly, including the creation of one new recommendation. In July 2021, a second and final vote was conducted including all of the recommendations where any changes had been proposed. Agreement was achieved in all recommendations. Throughout the guideline, after each recommendation, the percent of experts who voted "completely agree" or "somewhat agree" with each statement is shown in parentheses.* Bone.scan.and.brain.imaging.in.patients.with.symptoms.or.poor.prognosis.metastatic. disease..CT:..computed.tomography.

Accuracy of germ cell tumor histology and stage within a Canadian cancer registry

“…As well, education on how to interpret elevated tumour markers in the setting of a needle biopsy or no biopsy (eg. βHCG >5000 IU/L or any abnormal AFP should be coded as NSGCT) 5 would be helpful, along with the knowledge that the term teratocarcinoma is outdated and that the predominant histology is not always the one to record. With regards to the stage, over half of the discrepancies could be resolved with specific coder education around the definition of stage IS disease and the need to follow the tumour markers post-orchiectomy.…”

Guideline of guidelines: follow‐up after orchidectomy for clinical stage 1 testicular cancer

“…The EAU and ESMO-EURACAN guidelines recommend offering surveillance or risk-adapted (one course of BEP) treatment based on LVI status, but they emphasise the standard option of care for high-risk NSGCT is adjuvant chemotherapy, and surveillance could be reserved for patients not willing to undergo chemotherapy [14,19]. The AUA and NCCN guidelines recommend a shared-decision making between surveillance, adjuvant chemotherapy (one cycle of BEP), or nerve-sparing RPLND for patients with CS1 NSGCT [15,16,18,20]. However, they advocate that if the patient has no risk factors and is willing and able to adhere to a surveillance programme, surveillance should be the preferred management option.…”

Fertility preservation in uro-oncology

“…The American Society of Clinical Oncologists recommends that everyone diagnosed with cancer in their reproductive years be counseled on the possibility of infertility and fertility preservation. These recommendations are echoed by multiple urological organizations surrounding testicular cancer, as well as pediatric cancer groups [5,6 & ,7…”

“…The American Society of Clinical Oncologists recommends that everyone diagnosed with cancer in their reproductive years be counseled on the possibility of infertility and fertility preservation. These recommendations are echoed by multiple urological organizations surrounding testicular cancer, as well as pediatric cancer groups [5,6 ▪ ,7 ▪▪ ]. For patients, counseling from fertility specialists and a greater understanding of the fertility consequences of cancer treatment can improve QoL, life satisfaction, and reduce feelings of regret [8,9].…”