Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline Amendment 2023

Abstract

Purpose:The purpose of this American Urological Association (AUA) guideline amendment is to provide a useful reference on the effective evidence-based treatment strategies for early-stage testicular cancer.Methodology/Methods:The original methodology protocol included searches of PubMed®, Embase®, and the Cochrane Central Register of Controlled Trials (CENTRAL) from January 1980 through August 2018. The search strategy used medical subject heading (MeSH) terms and key words relevant to the diagnosis and treatment of early-stage testicular cancer. The searches conducted for the update presented herein utilized the same methodological protocol to capture literature published through March 2023. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions.Results:Updates were made to statements on imaging, seminoma management, non-seminoma management, surveillance for stage I testicular cancer, and additional survivorship. Further revisions were made to the methodology and reference sections as appropriate.Conclusions:This guideline seeks to improve clinicians’ ability to evaluate and treat patients with early-stage testicular cancer based on currently available evidence. Future studies will be essential to further support or refine these statements to improve patient care.

Multifocality in Testicular Cancer: Clinicopathological Correlations and Prognostic Implications

“…The finding of multifocality can have significant implications for patients who are eligible for organ-sparing surgery. According to the current guidelines, partial orchiectomy (PO) is considered a valid treatment option in a setting of a congenitally acquired or functionally solitary testis or bilateral synchronous tumors [25,37]. Based on the American Urological Association (AUA) guideline, PO can be offered as an alternative to radical orchiectomy in carefully selected patients wishing to preserve hormonal and fertility function with masses < 2 cm, equivocal physical exam or ultrasonography findings and negative tumor markers [37].…”

Testicular cancer with small metastatic burden: optimal approach in 2024

“…Overall, early trials show that de-escalated chemotherapy/radiation therapy regimens and primary RPLND can achieve comparable short-term outcomes to standard therapies for select patients. Based on the SEMS data, RPLND is now included in a recent 2023 AUA guideline amendment as an appropriate and effective treatment option for patients with CS IIA/B seminoma with a lymph node 3 cm or less who wish to avoid long-term chemotherapy or radiation toxicity [28].…”